拉米夫定与恩替卡韦预防B细胞非霍奇金淋巴瘤化疗后乙型肝炎病毒再激活的疗效对比及乙型肝炎再发危险因素分析

Comparison of lamivudine and entecavir in preventing hepatitis B reactivation in B-cell non-Hodgkin's lymphoma patients during chemotherapy and the risk factors of hepatitis B occurrence

目的 对比拉米夫定与恩替卡韦预防B细胞非霍奇金淋巴瘤（B-NHL）合并慢性乙型肝炎病毒（HBV）感染的患者接受利妥昔单抗联合化疗期间出现HBV再激活的疗效及化疗后乙型病毒肝炎发生的危险因素.方法 回顾性分析109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、肝损伤发生率及病死率.其中79例接受拉米夫定治疗,30例接受恩替卡韦治疗;所有患者在化疗开始前1周开始接受拉米夫定或恩替卡韦治疗,疗程至化疗结束后6个月.结果 拉米夫定组及恩替卡韦组HBV再激活率分别为31.6％、10.0％;肝功能损伤发生率分别为27.8％、6. 7％;HBV相关肝炎发生率分别为24.1％、3. 3％;化疗中断发生率分别为22.8％、3. 3％,两组比较差异均有统计学意义（均P＜0.05）;两组患者的病死率分别为2. 5％、0,差异无统计学意义（P＞0.05）.化疗过程中,出现HBV再激活的患者,多数为Ⅲ ～Ⅳ期的B-NHL患者.结论 恩替卡韦相较于拉米夫定在预防治疗B-NHL化疗期间HBV激活上,具有更好的疗效;特别是对于分期较晚的B-NHL患者,恩替卡韦可作为首选药物.

Objective This study was designed to compare the efficacy of lamivudine and entecavir in preventing hepatitis B reactivation in B-cell non-Hodgkin＇s lymphoma （B-NHL） patients undergoing rituximab-based treatment.Methods A retrospective study of the prevalence and mortality of HBV reactivation and the rates of hepatitis in 109 cases of patients with HBV virus and B-NHL undergoing rituximab-based chemotherapy treatment was taken,A total of 79 patients received lamivudine and 30 patients received entecavir.These patients received either lamivudine or entecavir during chemotherapy and for 6 months after completion of chemotherapy.Results The rates of hepatitis B reactivation in the lamivudine group or entecavir group were 31.6％ and 10.0％; the occurrence rates of liver function damage were 27.8％ and 6.7％,the rates of HBV-related hepatitis were 24.1％ and 3.3％;and the disruption of chemotherapy were 22.8％ and 3.3％,respectively,with statistical significance （P＜0.05）.There were no significant difference in mortality （2.5％ vs 0）.Most of all patients with hepatitis B reactivation had B-cell non-Hodgkin＇s lymphoma （stage Ⅲ-Ⅳ）.Conclusion In B-NHL patients under rituximab combination chemotherapy treatment,entecavir is more effective than lamivudine in preventing hepatitis B reactivation.For patients with advanced stage disease,entecavir should be considered the primary preventive therapy.