拉米夫定预防B细胞非霍奇金淋巴瘤患者利妥昔单抗化疗后乙型肝炎病毒再激活的临床分析

Clinical analysis of prophylactic lamivudine reduced hepatitis B virus reactivation in patients with B-cell non-Hodgkin ＂s lymphoma receiving rituximab combination chemotherapy

目的研究利妥昔单抗联合化疗治疗B细胞非霍奇金淋巴瘤（B—NHL）合并乙型肝炎病毒（HBV）携带患者的安全性，探讨拉米夫定预防性治疗的价值。方法回顾性分析含利妥昔单抗联合化疗前后B—NHL患者乙型肝炎五项、HBV．DNA和肝功能指标变化。将39例HBV核心抗体（HBcAb）（＋）／HBV表面抗体（HBsAb）（-）的B—NHL患者分为拉米夫定预防组和对照组，比较两组化疗后HBV再激活、肝功能损害等指标。结果108例接受利妥昔单抗联合化疗的B—NHL患者中，15例患者为HBV表面抗体（HBsAg）（＋），占所有患者的13．89％；39例为HBsAg（-）／HBcAb（＋）患者，占所有患者的36．11％。15例HBsAg（＋）的患者中HBV再激活率为13．3％，13例拉米夫定预防患者中1例（7．7％）HBV再激活，2例未预防的患者中1例HBV再激活。39例HBsAg（-）／HBcAb（＋）患者中HBV再激活率为7．7％（3例），14例拉米夫定预防组HBV再激活率为0，25例未预防的患者中3例（12％）HBV再激活。结论B—NHL合并HBV携带患者在利妥昔单抗联合化疗导致HBV再激活的风险是可控的，预防性使用拉米夫定能明显降低HBV再激活。

Objective To investigate the safety of rituximab combination chemotherapy in the treatment of B-cell non-Hodgkin＂ s lymphoma （B-NHL） complicated with hepatitis B virus （HBV） infection, and assess the incidence of HBV reactivation reduced by prophylactic lamivudine. Methods A retrospective study of HBV-related markers, HBV-DNA and liver function was performed before and after rituximab- containing treatment in B-NHL patients. Thirty nine B-NHL patients with HBcAb（＋）/HBsAb（-） were divided into prophylactic group （14 cases） and control group （25 cases）. The incidences of HBV reactivation, functional damage of liver were measured. Results Among the 108 B-NHL patients who received rituximab combination chemotherapy, 15 （13.89 %） were HBsAg （＋） and 39 （36.11%） HBsAg （-） / HBcAb （＋）. Of the 15 HBsAg （＋） patients, 2 （13.3 %） experienced reactivation of HBV. The prevalence of HBV reactivation was 7.7 %（1/13） in patients who received prophylactic antiviral treatment and 50 % （1/2） in those who did not receive lamivudine. Among the 39 HBsAg （-） / HBeAb （＋） patients, 3 cases （7.7 %） experienced reactivation of HBV. The prevalence of HBV reactivation was 0 in patients who received prophylactic lamivudine treatment and 12 % （3/25） in those who did not receive this antiviral drug. Conclusion Prophylactic lamivudine before rituximab combination chemotherapy can reduce HBV reactivation obviously.