免疫化疗对HBsAg阴性/抗-HBc阳性T细胞非霍奇金淋巴瘤患者乙型肝炎病毒再激活的影响

Impact of immunochemotherapy on hepatitis B virus reactivation in HBsAg negative/anti-HBc positive T-cell non-Hodgkin's lymphoma patients:a retrospective cohort study

目的评价免疫化疗对乙型肝炎表面抗原(HBsAg)阴性/乙型肝炎核心抗体(抗-HBc)阳性T细胞非霍奇金淋巴瘤(NHL)患者乙型肝炎病毒(HBV)再激活的影响及相关因素。方法回顾性分析2012~2020年北京大学第三医院血液科收治的NHL患者,试验组为未接受预防性抗病毒的56例HBsAg阴性/抗-HBc阳性的T细胞NHL患者,对照组为接受预防性抗病毒治疗的65例HBsAg阳性B细胞NHL患者,比较2组患者间临床特点、HBV再激活发生率及免疫化疗对HBV再激活的影响。结果试验组与对照组患者在Ann Arbor分期、B症状及总化疗疗程方面比较,差异均无统计学意义(均P>0.05)。对照组HBV再激活发生率(13.8%)显著高于实验组(1.8%),差异有统计学意义(P<0.05)。试验组1例HBV再激活,无HBV再激活肝炎及肝衰竭;对照度9例HBV再激活,5例患者因HBV再激活中断化疗或利妥昔单抗治疗,其中HBV再激活肝炎2例,肝衰竭1例。相关分析显示HBV再激活与HBsAg阳性及应用利妥昔单抗疗程呈正相关。结论未预防性抗病毒治疗的HBsAg阴性/抗-HBc阳性T细胞NHL患者免疫化疗后HBV再激活发生率显著低于接受预防性抗病毒治疗的HBsAg阳性B细胞NHL患者,且预后相对好。

Objective To investigate the effect of immunochemotherapy on hepatitis B virus(HBV)reactivation and related factors in HBsAg negative/anti-HBC positive patients with T-cell nonHodgkin's lymphoma(NHL).Methods In this retrospective study,NHL patients treated at the Department of Hematology of the Peking University Third Hospital from 2012 to 2020 were analyzed.The patients were divided into either an experimental group.The experimental group consisted of 56 HBsAg negative/anti-HBC positive T-cell NHL patients who did not receive antiviral prophylaxis,and the control group was composed of 65 HBsAg positive B-cell NHL patients who received antiviral prophylaxis.Results There was no significant difference between the two groups in Ann Arbor stage,B symptoms,and total chemotherapy course(P>0.05).The incidence of HBV reactivation in the control group(13.8%)was significantly higher than that of the experimental group(1.8%;P<0.05).One patient in the experimental group had HBV reactivation;nine patients in the control group had HBV reactivation,of whom 5 discontinued chemotherapy or rituximab treatment due to HBV reactivation,including 2 cases of reactivated hepatitis B and 1 case who died of hepatic failure.Correlation analysis showed a positive correlation between HBV reactivation and HBsAg positivity,as well as the duration of treatment with rituximab.Conclusion The incidence of HBV reactivation after immunochemotherapy in HBsAg negative/anti-HBC positive T-cell NHL patients without antiviral prophylaxis is significantly lower than that of HBsAg positive B-cell NHL patients who received antiviral prophylaxis,with a relatively good prognosis.