多发性骨髓瘤患者HBsAg检测及HBV感染的风险研究

Monitoring of HBsAg and Risk of HBV Infection in Patients with Multiple Myeloma

目的:探究多发性骨髓瘤患者HBsAg的检出率情况及HBV感染的风险。方法:自2012年5月至2014年7月我院共收入初次确诊为多发性骨髓瘤患者114例,以110例同期健康体检者为对照组,比较2组HBsAg阳性率、HBV感染率,比较多发性骨髓瘤患者化疗前后HBV感染率。依据检测结果将所有患者分为HBsAg^+和HBsAg^-组,比较2组患者治疗前后肝损伤情况。对HBsAg^+且HBV-DNA^+患者进行预防性抗病毒治疗,对其它患者则不进行预防性抗病毒治疗,检测各组患者HBV再激活情况。结果:多发性骨髓瘤患者HBsAg阳性率较对照组略高,但不具有统计学意义(P>0.05)。HBsAg阳性组治疗前肝损伤发生率及程度较阴性组高,治疗后二者差异更显著(P<0.05)。进行预防性抗病毒治疗的4例HBsAg^+患者未出现HBsAg再激活,6例未进行抗病毒治疗的HBsAg^+患者中有2例出现HBsAg再激活,HBsAg^-患者中经治疗后有1例患者出现HBsAg再激活。多发性骨髓瘤患者化疗后HBV感染率较化疗前明显升高(P<0.05)。结论:多发性骨髓瘤患者HBV感染率较正常人高,且治疗过程中HBV隐匿性感染者也可能出现HBV再激活,HBV感染与多发性骨髓瘤之间具有一定相关性。对多发性骨髓瘤患者进行HBsAg监测有利于评估患者肝脏损伤情况。

Objective： To explore the incidence of HBsAg and the risk of HBV infection in patients with multiple myeloma（ MM）. Methods： A total of 114 newly diagnosed MM patients admitted in our hospital from May 2014 to July 2016 were enrolled in MM group,110 healthy persons were enrolled in control group. The HBsAg positive rate and HBV infection rate were compared between 2 groups; the HBV infection rate of MM patients was compared before and after chemotherapy.According to detected results,all patients were divided into HBsAg^＋ group and HBsAg-group,and the lever damage in 2 groups was compared before and after treatment. For HBsAg^＋ and HBV-DNA^＋ patients,the preventive antiviral treatment was performed,while for other patients the preventive antiviral treatment was not performed,then the HBV reactivation was tested in each group. Results： The incidence of HBsAg^＋ in MM patients seem a litter higher than that in control group without statistical significance（ P〉0. 05）; the incidence and severity of HBsAg^＋ group were higher than those of control group before treatment,moreover the difference between 2 groups was more significant after treatment（ P〈0. 05）. The HBsAg reactivation was not found in 4 pases with HBsAg^＋ who received the proventive antiviral treatment,while the HBsAg reactivation was observed in 2 cases out of 6 cases without proventive antiviral treatment; the HBsAg reactivation happened only in 1 case of HBsAg-- group after treatment. The HBV infection rate in MM patients after chemotherapy was significantly enhenced as compared with infection rate before chemotherapy（ P〈0. 05）. Conclusion： The HBV infection rate in MM patients is higher than that in normal persons,moreover tha HBV-reactivation may happen in patients with ocult HBV infection in process of treatment; the HBV infection correlates with MM to a certain degree. The monitoring HBsAg for MM patients contributes to evaluation of liver danage.