结肠滤泡性淋巴瘤伴拉米夫定耐药乙型肝炎患者的治疗分析与药学监护

Pharmaceutical care on a lamivudine-resistant patient with hepatitis B and colonic follicular lymphoma

1例61岁男性患者,既往有乙肝小三阳病史,规律服用拉米夫定(100 mg,qd)控制尚可,因"结肠滤泡性淋巴瘤Ⅲ期"入院。入院后行R-CHOP方案(利妥昔单抗500 mg,d1+环磷酰胺1 g,d1+表柔比星100 mg,d1+长春新碱2 mg,d1+泼尼松100 mg,d1-5,po)化疗,之后患者出现HBV DNA被激活。临床药师结合诊治指南并与医生积极讨论,分析患者可能产生拉米夫定耐药,后调整为恩替卡韦,密切关注其化疗前后生化指标,并对患者进行用药教育。后持续监护、随访后续化疗过程,患者未再出现乙肝再激活。

One 61-year-male patient was admitted mainly because ofⅢphase of colonic follicular lymphoma.The patient was a hepatitis B visus carrier with hepatitis B surface antigen(HBsAg)-positive,hepatitis B e antibody(HBeAb)-positive and hepatitis B core antibody(HBcAb)-positive and regularly took lamivudine(100 mg,qd).After admission,the R-CHOP regimen(rituximab 500 mg,d1+cyclophosphamide 1 g,d1+epirubicin 100 mg,d1+vincristine 2 mg,d1+prednisone 100 mg,d1-5,po)was given to him.And then result of HBV DNA test showed that HBV DNA was reactivated after chemotherapy.Based on relevant guidelines and deep discussion with doctors,clinical pharmacist considered that the patient developed lamivudine resistance.So lamivudine was replaced by entecavir.Detailed medication education was given to him by pharmacist.Blood biochemical test was performed before and after subsequent chemotherapy.Follow-up results showed that HBV DNA was controlled in subsequent chemotherapy.