拉米夫定对HBV-DNA阳性恶性肿瘤患者化疗所致HBV再激活的预防作用评价

Lamivudine for the prevention of hepatitis B virus(HBV) reactivation in hepatitis B virus DNA seropositive cancer patients undergoing chemotherapy

目的:探讨拉米夫定对HBV-DNA阳性恶性肿瘤患者化疗所致HBV再激活的预防作用。方法:选择HBV-DNA阳性恶性肿瘤患者60例,分成两组,即试验组与对照组各30例。试验组在化疗前2周给予拉米夫定(100mg口服,qd,直至化疗结束后8周)。预防性治疗,观察化疗前后HBV-DNA水平变化情况,并与对照组比较。结果:试验组化疗后出现肝功能损害12例(40%),HBV-DNA均<104copies/ml,仅有1例HBV再激活。对照组肝功能损害23例(76.7%),HBV-DNA>104copies/ml 22例(73.3%),>109copies/ml8例(26.7%),其中有7例(23.3%)HBV再激活。试验组HBV再激活率明显低于对照组(3.3%vs23.3%,P<0.05),且肝功能损害率亦较低(40%vs 76.7%,P<0.05)。结论:拉米夫定可以有效预防和治疗HBV再激活,对防治HBV-DNA阳性的恶性肿瘤患者化疗所致肝损害有较好的效果。

Objective： To assess the preventive efficacy of lamivudine in reducing the incidence of hepatitis B virus （HBV） reactivation during eytotoxic chemotherapy. Methods： Total of 60 patients histologically proved malignant tumor with HBV- DNA positive were divided into two groups： the research group （prophylactic lamivudine group） and the control group （without prophylactic lamivudine group）. In the research group, 100mg daily lamivudine was administered 2 weeks before and until 8 weeks after discontinuing chemotherapy. HBV - DNA levels were observed before and after completion of chemotherapy, and the outcomes were compared between the two groups. Results： In research group, HBV-DNA levels were less than 10^4copies/ml, and there were 12 patients developed hepatic toxici-ty. Only one patient in the preventive lamivudine group developed HBV reactivation. In the control group, HBV - DNA levels were more than 10^4copies/ml, there were 23 patients developed hepatic toxicity and 7 patients developed HBV reactivation. In prophylactic lamivudine group, there was significantly less HBV reactivation（3.3% vs 23.3% in the controls, P 〈 0.05 ） and fewer incidences of hepatic toxicity（40% vs 76.7%, P 〈 0.05 ）. Conclusion ： Prophy-lactic lamivudine can significantly reduce the incidence of HBV reactivation and hepatic toxicity of cancer patients with HBV - DNA seropositive undergoing cytotoxic chemotherapy.