抗肿瘤药物和免疫抑制剂相关的乙型肝炎病毒再激活

Hepatitis B virus reactivation associated with antineoplastic drugs and immunosuppressive agents

肿瘤患者接受抗肿瘤联合化疗方案和免疫抑制剂治疗时可导致潜伏或静止状态的乙型肝炎病毒（HBV）发生再激活，出现肝炎症状，伴随HBV DNA水平高于基线10倍以上或绝对值大于20 000 IU/ml。HBV再激活可致4.5%～8.1%的患者死于肝病，23.3%～71.0%的患者中断或改变肿瘤化疗方案。肿瘤患者化疗后HBV 再激活的机制可能是抗肿瘤药物及免疫抑制剂抑制了机体对HBV起免疫作用的T细胞和自然杀伤细胞，导致HBV大量复制。肿瘤患者HBV再激活与患者的HBV感染状况、肿瘤类型和化疗方案有关。拉米夫定等核苷（酸）类药物可有效预防和治疗肿瘤患者的HBV再激活。肿瘤患者接受化疗前应常规进行HBV筛查，对高风险患者预防性使用核苷（酸）类药物可明显降低HBV再激活的发生率和严重程度。

Hepatitis B virus （HBV） in a dormant or latent state in patients with cancer may be reactivated when the patients receive antineoplastic combined chemotherapy protocols or immunosuppressive agents therapy. Then, the patients develop symptoms of hepatitis, accompanied by HBV DNA levels exceeding more than 10 times of basic level or absolute HBV DNA levels 〉 20,000 IU/ml. Due to HBV reactivation, 4.5%-8. 1% patients dead from liver disease and 23.3%-71.0% of patients＇chemotherapy program have to he discontinued or changed. The mechanism of HBV reactivation may be that antineoplastic agents and immunosuppressive agents suppress the function of T cells and natural killer cells and massive viral replication is induced subsequently. The HBV reactivation in cancer patients is in relation to the stages of HBV infection, the type of malignancy, and the chemotherapy protocols. Lamivudine and other nucleos （t） ide analogues could be used to prevent and treat effectively HBV reactivation in cancer patients. Patients with cancer should be screened for HBV infection before receiving chemotherapy. A preventive use of nucleos（t） ide analogues is effective to decrease the incidence and severity of HBV reactivation in high-risk patients.