HBV感染与弥漫性大B细胞淋巴瘤患者临床特征及化疗后肝功能的关系

Relationship between HBV infection and clinical characteristics of diffuse large B-cell lymphoma patients,and liver function after chemotherapy

目的探讨乙型肝炎病毒(HBV)感染与弥漫性大B细胞淋巴瘤(DLBCL)患者临床特征及化疗后肝功能的关系。方法选取2017年10月-2020年12月南阳市第二人民医院收治的HBsAg阳性DLBCL患者47例纳入HBsAg阳性组,HBsAg阴性DLBCL患者70例纳入HBsAg阴性组,比较两组患者临床分期、脾脏受累、淋巴结外器官受累、国际预后指数评分(IPI),分析HBsAg阳性组患者化疗前HBV-DNA病毒载量及化疗后病毒再激活与肝功能损伤的关系。结果HBsAg阳性组与HBsAg阴性组性别、年龄、淋巴结外器官受累数量、IPI评分比较差异无统计学意义,HBsAg阳性组临床分期Ⅲ~Ⅳ期、脾脏受累比例高于HBsAg阴性组(P<0.05);HBsAg阳性组化疗后肝功能损伤发生率为(48.94%)高于HBsAg阴性组(22.86%)(P<0.05);HBsAg阳性组不同HBV-DNA载量患者肝功能损伤发生率比较差异有统计学意义(P<0.05),HBV-DNA>10^(7)拷贝/ml患者肝功能损伤发生率为77.78%(7/9),<10^(3)拷贝/ml患者肝功能损伤发生率为18.18%(2/11);HBsAg阳性组化疗后HBV再激活患者肝功能损伤发生率高于未激活患者(P<0.05)。结论HBsAg阳性DLBCL患者相较于HBsAg阴性患者临床分期高,脾脏受累风险更高,患者化疗后肝脏损伤程度与HBV病毒载量相关,HBV再激活患者预后相对较差。

OBJECTIVE To explore the relationship between hepatitis B virus(HBV)infection and clinical characteristics of patients with diffuse large B-cell lymphoma(DLBCL),and liver function after chemotherapy.METHODS Totally 47 HBsAg-positive DLBCL patients who were treated in Nanyang Second People′s Hospital from Oct 2017 to Dec 2020 were assigned as the HBsAg-positive group,and 70 HBsAg-negative DLBCL patients were chosen as the HBsAg-negative group.The clinical stage,involvement of spleen,involvement of extranodal organs and international prognostic index(IPI)were observed and compared between the two groups of patients,and the relationship between HBV-DNA load before chemotherapy,viral rectivation after chemotherapy and damage of liver function of the HBsAg-positive patients was analyzed.RESULTS There were no significant differences in the gender,age,number of extranodal organs involved and IPI score between the HBsAg-positive group and the HBsAg-negative group.The proportions of patients with clinical stageⅢandⅣand involvement of spleen were significantly higher in the HBsAg-positive group than in the HBsAg-negative group(P<0.05).The incidence of liver function damage of the HBsAg-positive group was 48.94%after chemotherapy,significantly higher than 22.86%of the HBsAg-negative group(P<0.05).In the HBsAg-positive group,there was significant difference in the incidence of liver function damage among the patients with different HBV-DNA loads(P<0.05);the incidence of liver function damage of the patients with HBV-DNA load more than 107 copies/ml was 77.78%(7/9),the patients with HBV-DNA load less than 10^(3)copies/ml 18.18%(2/11).In the HBsAg-positive group,the incidence of liver function damage of the patients with rectivation of HBV was significantly higher than that of the patient without activation(P<0.05).CONCLUSION As compared with the HBsAg-negative DLBCL patients,the HBsAg-positive DLBCL patients have higher clinical stage and are at higher risk of involvement of spleen.The severity of liver damage is associated with the HBV load,and the patients with HBV reactivation have poor prognosis.