恶性肿瘤患者化疗后乙型肝炎病毒再激活

Hepatitis B Virus Reactivation in Cancer Patients Undergoing Chemotherapy

相当一部分乙型肝炎表面抗原阳性的恶性肿瘤患者在化疗后会出现乙型肝炎病毒再激活。可表现为不同程度的肝功能损害,从而导致化疗中断,影响患者的预后。乙型肝炎病毒再激活的危险因素包括化疗前的HBV-DNA载量,使用糖皮质激素、利妥昔单抗及诊断为乳腺癌、非霍奇金淋巴瘤。预防性使用拉米夫定可降低乙型肝炎病毒再激活的发生率及其相关的发病率。乙型肝炎表面抗原阳性的患者在化疗前应预防性抗病毒治疗。化疗期间除监测肝功能外,应常规监测HBV-DNA。

HBV reactivation occurred in a significant proportion of HBsAg positive patients undergoing chemotherapy,which can result in varying degrees of liver damages,causing disruption of chemotherapy and compromising the patients′ prognosis.The identified risk factors include detectable pre-chemotherapy HBV DNA load,the use of glucocorticoid or rituximab and diagnosis of breast cancer or non-Hodgkin′s lymphoma.The anti-viral agent,lamivudine,can reduce the chance of HBV reactivation and its associated morbidity.Prophylactic antiviral treatment should be given to HbsAg-positive patients before initiating chemotherapy.In addition to monitoring of liver functions,the routine detection of HBV-DNA should be carried out during chemotherapy.