丙肝患者接受免疫抑制治疗对发生肝炎、丙肝病毒再激活的影响

Study on the reactivation of hepatitis and hepatitis C virus after immunosuppressive therapy in patients with hepatitis C

目的探讨丙肝患者接受免疫抑制治疗对肝炎发生、丙型肝炎病毒(HCV)再激活的影响。方法收集整理2012年1月至2017年12月期间漯河市中心医院HCV感染且接受免疫抑制治疗患者的临床资料,进行统计学分析。结果针对肝炎活动风险的统计学研究显示,入组的310例患者接受免疫抑制治疗后,102例(32.9%)出现肝炎活动;患者原发病(实体瘤、血液恶性肿瘤及其他)在肝炎的发病率上差异无统计学意义(χ~2=3.908,P=0.14);接受治疗后,化疗和(或)靶向治疗组患者发生肝炎概率高于皮质类固醇激素和(或)免疫抑制剂组(χ~2=4.09,P=0.04)。针对化疗和(或)靶向治疗组患者用药前后HCV再激活风险评估的研究显示,入组210例患者中,38例(18.1%)发生了HCV再激活;血液肿瘤组患者发生HCV再激活率显著高于实体瘤组(χ~2=4.102,P=0.04)。针对肝炎发生与HCV再激活的关联性研究显示,病毒再激活组发生肝炎概率明显高于病毒未激活患者(χ~2=4.54,P=0.03)。结论 HCV感染患者,接受系统化疗和(或)靶向治疗时发生肝炎风险高于接受皮质类固醇和(或)免疫抑制剂患者。接受系统化疗和(或)靶向治疗时,血液肿瘤患者发生HCV再激活风险高于实体瘤患者,且可能会通过病毒再激活增加肝炎发生的风险。

Objective To investigate the effect of immunosuppressive therapy in patients with hepatitis C infection on hepatitis occurrence and hepatitis C virus reactivation. Methods Statistical analysis of clinical data on patients with hepatitis C infection and immunosuppressive therapy from January 2012 to December 2017. Results Statistical studies on the risk of hepatitis activity showed that 102 cases(32.9%) had hepatitis activity after 310 patients in the group underwent immunosuppressive therapy. There was no statistically significant difference in the incidence of hepatitis in patients with primary affection(solid tumor,hematologic malignancy and others)(χ^2 = 3.908,P = 0.14). The rate of hepatitis in the chemotherapy and/or targeted treatment group patients was higher than corticosteroid and/or immunosuppressive group after treatment(χ^2 = 4.09,P = 0.04). A study of the risk assessment of HCV reactivation before and after medication in patients with chemotherapy and/or targeted therapy group showed that 38 patients( 18.1%) of the 210 patients in the group had an HCV reactivation. The reactivation rate of HCV was significantly higher in patients with blood tumor group than solid tumor(χ^2 = 4.102,P = 0.04). The studies on the correlation between the occurrence of hepatitis and the reactivation of HCV showed that the probability of occurring hepatitis in the virus reactivation group was significantly higher than that of the non-activated patients(χ^2 = 4.54,P = 0.03). Conclusions Among the patients with hepatitis c infection,the risk of hepatitis is higher in patients who receive systemic chemotherapy and/or targeted treatment than patients with corticosteroids and/or immunosuppressants. When undergoing systemic chemotherapy and/or targeted therapy,the risk of HCV reactivation is higher in blood tumor patients than solid tumor patients,and may increase the risk of hepatitis by activating the virus.