利妥昔单抗治疗致淋巴瘤患者乙型肝炎病毒再激活的机制及预防

Mechanism and prevention of hepatitis B virus reactivation in lymphoma patients after rituximabtherapy

既往HBV感染的淋巴瘤患者给予利妥昔单抗治疗期间，有发生HBV再激活的风险。国内外的各个指南和专家共识均推荐，此类人群治疗前需要进行HBV血清学检测，在应用利妥昔单抗之前或同时，需要恩替卡韦或替诺福韦进行预防性抗病毒治疗直到停用利妥昔单抗12-18个月；在治疗过程中也需要监测患者的HBVDNA载量和肝功能。此文就HBV再激活的定义、HBV与淋巴瘤的关系、HBV再激活流行病学特征和危险因素、临床特点、监测、预防和治疗等进行综述。

Lymphoma patients with HBV resolved （HBsAg-negative/anti-HBc-positive） infection has the risk of viral reactivation during rituximab-based therapy. HBV serological testing prior to this therapy is recommended by several national and international medical agencies and expert panels. Patients need to start antiviral therapy with entecavir or tenofovir prior to the initiation of rituximab and continue this treatment for 12 to 18 months after rituximab therapy to avoid late HBV reactivation. Monitoring of HBV DNA viral load and liver function should be done during rituximab-based therapy. This article reviews the definition of HBV reactivation, the relation between HBV and lymphoma, epidemic features and risk factors, clinical features, surveillance, prevention and treatment of HBV reactivation.