血液系统恶性肿瘤患者乙型肝炎病毒感染的临床分析

Clinical analysis of hemopathy patients with HBV infection

目的:回顾性分析乙型肝炎病毒(HBV)感染在住院的血液系统疾病患者中分布情况及化疗后影响。方法:对205例血液系统疾病患者临床资料进行回顾性分析,根据血液系统疾病及乙肝病毒抗原、抗体检测结果不同分组,以200例同期体检人员为对照,统计总体乙肝病毒感染率及治疗后肝功能损害情况。结果:淋巴瘤组HBsAg阳性率为22.95%,与体检组及其他疾病组差异有统计学意义(P<0.05);治疗前肝功能异常发生率HBV感染组为14.67%,HBV未感染组的5.38%,差异有统计学意义(P<0.05);治疗后肝功能损害发生率HB-sAg阴性HBeAb、HBcAb阳性组为51.28%,HBV未感染组为22.31%,两者差异有统计学意义(P<0.05)。结论:淋巴瘤患者中HBV感染率明显增高。对予HBsAg阳性患者,早期应用抗病毒药物拉米夫定并加强护肝治疗能有效降低HBV-DNA激活及肝功能损害发生率。HBsAg阴性而HBeAb、HbcAb阳性患者临床医生应提高警惕,早期检测HBV-DNA,加强护肝治疗强度,定期监测HBV-DNA及肝功能。

Objective：To study the hepatitis B virus（HBV） infection rate in patients with hematologic neoplasm and observe the chemotherapy related hepatic injury through retrospective analysis.Method：The HBV infection status and the liver founction before and after chemotheraphy were investigated through retrospective analysis in 205 cases of hematologic neoplasm,and a total of 200 normal people in the corresponding period served as control.Result：The hepatic injury rate in patients with HBV infection was highter than that of patients only with positive HBsAb（P0.05） before chemotherapy;The positive rate of HBsAg in lymphoma patients was 22.95%,singificantly higher than that in control group and other three groups（P0.05）;The hepatic injury rate induced by chemotherapy in HBeAb and HBcAb positive and HBsAg negative patients group was 51.28%,highter than that of patients without HBV infection（22.31%）.Conclusion：The prevalence of HBV infection was significantly higher in lymphoma patients than general population.It was important for HBsAg positive patients to use lamivudine at the early stage to inhibit the HBV DNA replication and hepatic injury.Regular measurement of HBV-DNA and liver function should be focused on those patients with negative HBsAg,but positive HBeAb and HBcAb.