预防性保肝治疗对经拉米夫定治疗的HBsAg阳性血液肿瘤患者的必要性研究

The necessity of prophylactic liver protective therapy in HBsAg-positive patients with hematological malignancy during chemotherapy and after the treatment of lamivudine

目的探讨经拉米夫定抗病毒治疗后,乙肝表面抗原(HBsAg)阳性血液恶性肿瘤患者化疗期间预防性保肝治疗的必要性。方法回顾性分析74例HBsAg阳性血液系统恶性肿瘤患者临床资料,并对其化疗期间预防性保肝治疗后肝功能损伤发生率予以比较分析。结果 HBsAg阳性患者,在予以拉米夫定后,加用保肝治疗未进一步降低化疗后肝功能损伤发生率。对于HBsAg阳性患者,未予以拉米夫定预防HBV活化,仅予以预防性保肝治疗仍未降低化疗相关的肝功能损伤发生率。HBsAg阳性血液恶性肿瘤化疗前开始拉米夫定抗病毒治疗,肝功能损伤发生率为22.5%,未经拉米夫定治疗组为44.1%,且有统计学差异(P=0.048)。结论 HBsAg阳性血液系统恶性肿瘤,应于化疗前及化疗全程予以核苷酸类似物抗病毒治疗,预防HBV再激活,而无必要予以预防性保肝治疗。对于简化HBsAg阳性血液肿瘤患者化疗前后的保肝治疗具有指导意义。

Objective To explore the necessity of prophylactic liver protective therapy in HBsAg-positive patients with hematological malignancy during chemotherapy and after the treatment of lamivudine. Methods We retrospectively analyzed clin- ical data from 74 HBsAg-positive patients with hematological malignancy. The incidences of liver function damage after chemother- apy were compared in the patients treated with preventive liver protective therapy or not and those who received lamivudine or not. Results There is no significant difference in the patients treated with preventive liver protective therapy or not, who accepted larnivudine initially. The incidence of liver function damage in HBsAg-positive patients with hematological malignancy treated with lamivudine was 22. 5% ,while in those who did not receive lamivudine the incidence was 44. 1% （P =0. 048）. Conclusion It is essential for HBsAg-positive patients with hematological malignancy to be treated with nucleotide analogues, for whom it is not nee- essary to receive additional prophylactic liver protective therapy.