伴乙型肝炎病毒感染的淋巴瘤患者化疗后肝损伤及乙型肝炎病毒激活情况分析

Liver damage and HBV re-activation after chemotherapy in lymphoma patients with HBV infection

目的 :探讨伴乙型肝炎病毒(hepatitis B virus,HBV)感染的淋巴瘤患者化疗后的肝损伤及HBV激活情况,为预防、治疗提供参考。方法:回顾性分析186例伴HBV感染的淋巴瘤患者化疗后的肝功能变化,并总结化疗后肝功能损伤相关因素及HBV再激活情况。结果:伴HBV感染的淋巴瘤患者中,化疗后发生肝损伤者多发于淋巴瘤Ⅲ、Ⅳ期,而采用预防性抗病毒治疗后,患者化疗后肝功能损伤率明显下降。化疗方案中同时应用糖皮质激素及表阿霉素的患者,肝功能损伤的发生率较未应用上述2种化疗药物者明显高。接受含美罗华化疗方案化疗的患者更易导致HBV再激活(21.8%比8.4%),这部分患者中未进行预防性抗病毒治疗者的HBV再激活率明显高于采取预防性抗病毒者(28.9%比5.9%)。结论:疾病分期、表阿霉素及糖皮质激素的应用与化疗后肝功能损害相关,可能成为化疗后肝功能损伤的高危因素。应用含美罗华化疗方案化疗更易导致HBV再激活,而预防性抗病毒治疗能显著降低HBV再激活率。

Objective： To investigate liver damage and HBV re-activation after chemotherapy in lymphoma patients with HBV infection and to provide a reference for therapy strategy. Methods： Changes in liver function after chemotherapy in 186 lymphoma patients with HBV infection were retrospectively analyzed, and the factors related to liver damage and HBV re-activation were analyzed. Results： Liver damage mainly occurred in patients with stage Ⅲ- Ⅳ lymphoma. The rate of liver damage decreased significantly in patients who received prophylactic antiviral therapy. Patients received chemotherapy with glucocorticoids and epirubicin had a higher incidence of liver damage than those without glucocorticoids and epirubicin. HBV could be more easily reactivated（21.8% vs 8.4%） in patients who had received rituximab-containing chemotherapy. Rate of HBV re-activation in patients treated with prophylactic antiviral therapy was lower than those without antiviral therapy（28.9% vs 5.9%）. Conclusions： Stage of lymphoma and use of adriamycin and glucocorticoids are related to liver damage after chemotherapy in lymphoma patients with HBV infection, and may be the high risk factors of liver damage. Use of rituximab containing chemotherapy regimens is more likely to result in HBV re-activation,and prophylactic antiviral therapy can significantly reduce the incidence of HBV re-activation.