拉米夫定预防B细胞非霍奇金淋巴瘤患者化疗后乙型肝炎病毒再激活的疗效研究

Effect analysis of prophylactic lamivudine on hepatitis B virus reactivation in patients with B-cell non-Hodgkin′s lymphoma undergoing prolonged chemo therapy

目的研究接受利妥昔单抗联合化疗的B细胞非霍奇金淋巴瘤(B-NHL)合并乙型肝炎病毒(HBV)感染患者的HBV再激活情况,探讨拉米夫定预防性治疗的价值。方法回顾性分析73例HBV感染的B-NHL患者在接受利妥昔单抗联合化疗后HBV再激活的发生率及病死率,其中43例为表面抗原HBsAg(+)患者,30例为HBsAg(-)/HBcAb(+)患者;将43例HBsAg(+)患者分为拉米夫定预防组25例和对照组18例,其中有5例患者接受长期利妥昔单抗维持性化疗,维持治疗的方法为巩固治疗结束后每3个月接受1次利妥昔单抗治疗,持续两年时间。结果 43例HBsAg(+)患者对照组与治疗组HBV再激活率分别为61.1%、16.0%;Ⅲ度肝功能损害的发生率分别为50.0%、8.0%,两组比较,差异均有统计学意义(P<0.05);两组患者的病死率分别为5.6%、0,差异无统计学意义;5例接受长期利妥昔单抗维持性化疗的患者,HBV再激活的发生率及病死率分别为80.0%、20.0%;30例HBsAg(-)/HBcAb(+)患者,预防组10例患者无1例再激活,对照组20例患者,有3例(15.0%)出现HBV再激活。结论预防性拉米夫定治疗可降低短期使用利妥昔单抗联合化疗的HBV再激活,利妥昔单抗的长期维持性治疗可能导致B-NHL患者HBV的再激活率增高,而拉米夫定对其的预防作用较为有限。

OBJECTIVE To investigate the hepatitis B virus reactivation after using combined chemotherapy of rituximab to treat the patients with B-cell non-Hodgkinr s lymphoma（B-NHL）, and assess the role of lamivudine prophylaxis. METHODS A retrospective study of the incidence and mortality of HBV reactivation in 73 cases of patients with HBV virus and B-NHL undergoing rituximab-based chemotherapy treatment was taken, among which there were 43 cases of patients with HBsAg（-^-）and 30 cases HBsAg（--）/HBcAb（＋）. Among of the 43 HBsAg（＋） patients, 25 received the prophylactic treatment of lamivudine taken as prevention group and 18 taken as control group. Five patients received long-term rituximab maintenance, once every 3 months for 2 years after consolidation treatment. RESULTS Among of the 43 HBsAg（＋）patients, the HBV reactivation rates in the prevention and control group were 61.1 ~/~0 and 16.0%, respectively; and the occurrence rates of ]I degree of liver {unction damage in both groups were 50.0 % and 8.0 %, respectlve[y, with statistical significance （P~ 0.05）. There was no significant difference in mortality between two groups （5.6~ vs. 0）. For patients undergoing long- term rituximab maintenance treatment, the incidence and mortality of HBV reactivation were 80.0% and 20.0%, respectively. Among the 30HBsAg（- ）/HBcAb（q-）patients, no patients in the prevention group underwent HBV reactivation, 3 cases （15.0M） in control group. CONCLUSION Using prophylactic lamivudine can reduce HBVreactivation in patients undergoing short-term rituximab treatment. A longer term rituximab treatment contributed to higher rate of HBV reactivation in HBsAg-positive patients with B-NHL.