乙型肝炎病毒表面抗原阴性伴核心抗体阳性非霍奇金淋巴瘤患者免疫化疗后肝炎病毒再激活的临床分析

Clinical analysis of hepatitis virus reactivation after immune chemotherapy in hepatitis B surface antigen(-) with hepatitis B core antibody( + ) patients with non-hodgkin's lymphoma

目的探讨乙型肝炎病毒（HBV）表面抗原（HBs Ag）阴性（-）伴核心抗体（Hbc Ab）阳性（＋）非霍奇金淋巴瘤患者免疫化疗后肝炎病毒再激活的临床意义。方法选择2005年1月至2012年1月间就诊并接受2个以上疗程免疫化疗的HBs Ag（-）伴HBc Ab（＋）非霍奇金淋巴瘤患者105例为研究对象,对其予以含利妥昔单抗的免疫化疗,观察免疫化疗后HBV再激活的发生情况。结果 105例HBs Ag（-）伴HBc Ab（＋）非霍奇金淋巴瘤患者中,HBV表面抗体（HBs Ab）（＋）者67例,占63.8%。105例患者中,肝功能损害Ⅰ~Ⅲ度者13例,其中1例患者出现了HBV再激活（1.0%）,12例证实与HBV再激活引起肝损害无关。1例出现了HBV再激活患者为男性、50岁,病理组织学提示为非霍奇金氏淋巴瘤,弥漫大B细胞性,在4次化疗后10 d发生HBV再激活,经治疗后病情好转。结论 HBs Ag（-）伴HBc Ab（＋）淋巴瘤患者免疫化疗后肝炎病毒再激活的临床发生率相对较小,目前对该类患者仍以常规HBV DNA检查、肝功能监测为主,以便更早的发现HBV携带者及感染者。

Objective To statistics the status of hepatitis virus reactivation after immune chemotherapy in hepatitis B surface antigen（ HBs Ag）（-） with hepatitis B core antibody（ HBc Ab）（ ＋） patients with non-hodgkin＇s lymphoma. Methods Between January 2005 and January 2012 in Affiliated Hospital of Beihua University,105 cases who received more than 2 courses of immune chemotherapy in HBs Ag（-） with HBc Ab（ ＋） patients with non-hodgkin＇s lymphoma as the research object. The patients were received the immune chemotherapy,including rituximab,to observe the immune chemotherapy after the happening situation of hepatitis B virus（ HBV） reactivation. Results Among 105 cases of HBs Ag（-） with HBc Ab（ ＋）in patients with non-hodgkin＇s lymphoma,67 cases（ 63. 8%） had HBV surface antigen antibody（ HBs Ab）（ ＋）. There were 13 cases of liver damage in 105 patients,and 1 patients（ 1. 0%） had HBV reactivation,and 12 cases had no related to HBV reactivation. One case of HBV reactivation was male,50-year old.Pathological examination showed non-Hodgkin＇s lymphoma,diffuse large B cell,and HBV reactivation occurred at 10 d after 4 cycles of chemotherapy. After treatment,the condition improved. Conclusions Clinical incidence of HBV reactivation after immune chemotherapy is relatively small in HBs Ag（-） with Hbc Ab（ ＋） patients with non-hodgkin＇s lymphoma. At present,the patients are still given HBV DNA and liver function monitoring,in order to earlier find HBV carriers and HBV patients.