HBV感染的乳腺癌患者化疗后HBV血清学标志物及肝功能变化分析

Changes of HBV serological markers and liver function of breast cancer patients with HBV infections after chemotherapy

目的探讨乙型肝炎病毒(HBV)感染的乳腺癌患者化疗后HBV血清学标志物及肝功能指标的变化情况及抗病毒感染在预防化疗所致的HBV再激活中的作用。方法收集医院2012年1月-2017年6月接受术后化疗的乳腺癌患者320例,根据化疗前患者是否合并HBV感染分为乙肝表面抗原(HBsAg)阳性组(109例)和阴性组(211例),比较两组患者化疗后肝功能损伤情况以及化疗前后阳性组HBV血清学标志物变化情况,分析预防性使用(44例)和未使用(65例)抗病毒感染治疗对阳性组中患者发生肝功能损伤及HBV再激活的影响。结果阳性组化疗后肝功能损伤发生率高于阴性组(P<0.001);化疗期间阳性组HBsAg滴度、丙氨酸转氨酶(ALT)和谷草转氨酶(AST)水平均显著上升;阳性组中,抗病毒感染治疗患者肝功能损伤率及HBV再激活率均显著低于未使用抗病毒感染治疗患者(P<0.05)。结论合并HBV感染的乳腺癌患者在化疗期间存在HBV再激活可能性,并易发生肝功能损伤,抗病毒感染治疗可预防化疗所致的HBV再激活。

OBJECTIVE To explore the changes of hepatitis B virus(HBV)serological markers and liver function of the breast cancer patients with HBV infections after chemotherapy and observe the effect of antiviral infection on prevention of HBV reactivation induced by chemotherapy.METHODS A total of 320 breast cancer patients who received postoperative chemotherapy from Jan 2012 to Jun 2017 were enrolled in the study and divided into the hepatitis B surface antigen(HBsAg)-positive group with 109 cases and the HBsAg-negative group with 211 cases according to the status of HBV infection before the chemotherapy.The liver function was compared between the two groups of patients after the chemotherapy,the changes of HBV serological markers of the HBsAg-positive group were observed before and after the chemotherapy,and the influence of prophylactic use(44 cases)and non-prophylactic use(65 cases)of antiviral infection therapy on liver function damage and HBV reactivation was analyzed.RESULTS The incidence of liver function damage of the positive group was significantly higher than that of the negative group after the chemotherapy(P <0.001).The HBsAg titer and levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)of the positive group were remarkably elevated during the chemotherapy.In the positive group,the incidence of liver function damage and rate of HBV reactivation were significantly lower in the patients who received the antiviral infection therapy than in the patients who did not receive(P<0.05).CONCLUSION The breast cancer patients complicated with HBV infection may have the possibility of HBV reactivation during the chemotherapy and are more likely to have liver function damage,and the antiviral infection therapy can prevent the HBV reactivation induced by the chemotherapy.