HBsAg阴性或抗-HBc阳性者肺癌术后辅助化学治疗中乙型肝炎病毒的再激活

Risk of hepatitis B reactivation in hepatitis B surface antigen negative/hepatitis B core antibody positive patients with lung cancer receiving adjuvant chemotherapy

目的探讨HBsAg阴性或抗-HBc阳性者肺癌术后辅助化学治疗中HBV的再激活及其相关危险因素。方法回顾性分析2003年1月到2011年12月接受辅助化学治疗的3280例肺癌术后患者，所有入组患者进行HBV血清学标志物和生物化学检测，并接受以顺铂为基础的辅助化学治疗方案。数据比较行χ^2检验。结果367例HBsAg阴性或抗-HBc阳性肺癌术后患者中，14例（3．81％）进展为乙型肝炎。单因素分析表明，患者年龄≥70岁（χ^2=13．003，P=0．019）、肝脏CT检查为脂肪肝或早期肝硬化（χ^2=11．225，P=0．026）和使用糖皮质激素累计剂量超过150mg（χ^2=7．008，P=0．033）是辅助化学治疗中HBV再激活的相关因素；而性别、基础辅助化学治疗方案与HBV的再激活无关联。结论肺癌术后的辅助化学治疗中，HBsAg阴性或抗-HBc阳性者有一定比例可以发生HBV的再激活。

Objective To identify the rate of hepatitis B virus （HBV） reactivation and potential risk factors in hepatitis B surface antigen negative/hepatitis B core antibody positive patients with lung cancer receiving adjuvant chemotherapy without concomitant antiviral prophylaxis. Methods The records of 3280 patients with lung cancer who received adjuvant chemotherapy were retrospectively reviewed from January 2003 to December 2011. Among these patients, 367 hepatitis B surface antigen negative/hepatitis B core antibody positive patients were analyzed for the HBV reactivation in this study. The HBV serology marker and biochemical tests of the 367 patients were performed. The data were analyzed by chi square test. Results Among 367 hepatitis B surface antigen negative/hepatitis B core antibody positive patients with lung cancer, 14 patients suffered HBV reactivation. Univariate analysis showed that age≥70 years（χ^2 = 13. 003,P= 0. 019）, abnormal liver computed tomography findings （（χ^2 =11. 225,P=0. 026） and the amount of corticosteroids≥150 mg（（χ^2=7. 008,P=0. 033） were associated with HBV reactivation. However, gender and adjuvant chemotherapy regimens were not related with HBV reactivation. Conclusion HBV reactivation occurs in a proportion of hepatitis B surface antigen negative/hepatitis B core antibody positive patients with lung cancer during adjuvant chemotherapy.