恩替卡韦和拉米夫定防治血液肿瘤化疗后乙型肝炎病毒再激活的临床研究

Clinical study of Entecavir vs.Lamivudine for prevention and treatment of hepatitis B virus reactivation in patients receiving chemotherapy for haematologic mlignancies

目的研究恩替卡韦和拉米夫定在防治化疗引起的血液肿瘤患者乙肝病毒(hepatitis B virus vaccine,HBV)再激活方面的疗效差异。方法选取珠江医院2014至2017年确诊为白血病或淋巴瘤合并HBV感染的化疗患者38例进行回顾性分析,化疗前检测肝功能、HBV五项标志物和血清HBV DNA水平,化疗开始后第一周、第二周以及随后的每月,均检测一次肝肾功能、HBV DNA。结果预防性接受抗病毒药物组的HBV再激活率低于未预防组(14.8%对63.6%,P<0.05)。淋巴瘤患者中拉米夫定组HBV再激活率比恩替卡韦组高(60.0%对7.1%,P<0.05)。无论化疗前HBV DNA水平是否高于检测下限,拉米夫定组和恩替卡韦组的HBV再激活率无统计学差异(P>0.05)。结论对于血液肿瘤合并HBV感染需要接受化疗的患者,建议预防性根据HBV DNA水平接受抗病毒药物治疗;对于淋巴瘤患者,推荐使用恩替卡韦。

Objective To investigate the efficacy of Entecavir and Lamivudine in preventing HBV reactivation in patients receiving chematherapy for haematologic malignancies.Methods A total of 38 patients with haematologic malignancies as well as HBV infection were studied retrospectively from 2014 to 2017 in Zhujiang Hospital of Southern Medical University.The liver function,renal function,serological markers of HBV and HBV DNA level were detected at base-line,and during the chemotherapy.Results The incidence of HBV reactivation in prophylactic antiviral drug group was lower than that in the non-prevention group(14.8%vs.63.6%,P<0.05).The incidence of HBV reactivation in Entecavir group was lower than that in Lamivudine group in lymphoma patients(7.1%vs.60.0%,P<0.05).Whether HBV DNA level was detectable,there was no statistical difference in HBV reactivation rate between Lamivudine group and Entecavir group(P>0.05).Conclusion For patients with haematologic malignancies as well as HBV infection who need chemotherapy,prophylactic antiviral therapy is recommended.Base line HBV DNA level should be considered when making antiviral strategy.For patients with lymphoma,it is recommended to use Entecavir.