Background &Aims: De novo hepatitis B virus (HBV)-related hepatitis after chemotherapy results in high morbidity and mortality. We evaluate the clinical course of de novo HBV-related hepatitis after chemotherapy. ...Background &Aims: De novo hepatitis B virus (HBV)-related hepatitis after chemotherapy results in high morbidity and mortality. We evaluate the clinical course of de novo HBV-related hepatitis after chemotherapy. Methods: Two hundred forty-four consecutive hepatitis B surface antigen (HBsAg)-negative lymphoma patients treated with chemotherapy were followed up for a median of 12.4 (range, 0.1-65.0) months. Serially collected serum samples were analyzed for hepatitis, serum HBV DNA, and HBsAg seroreversion. Results: Eight of the 244 patients (3.3%) developed de novo HBV-related hepatitis. A 100-fold increase in serum HBV DNA preceded de novo HBV related hepatitis by a median of 18.5 (range, 12-28) weeks. All 8 patients had normal serum alanine aminotransaminase level when the 100-fold increase in serum HBV DNA occurred. Patients with de novo HBV-related hepatitis were more likely to have occult HBV infection before chemotherapy. Direct sequencing results showed that these 8 patients had de novo HBV-related hepatitis from reactivation of occult HBV infection. Three of the 8 patients with de novo HBV-related hepatitis compared with 6 of the 236 patients without de novo HBV-related hepatitis developed fulminant hepatic failure (37.5%vs 2.5%, respectively, P < .001). On multivariate Cox analysis, de novo HBV-related hepatitis was independently associated with a higher risk of fulminant hepatic failure (relative risk, 29.854; 95%confidence interval: 4.844-183.980; P < .001). Conclusions: Close surveillance for a 100-fold increase in HBV DNA is recommended for HBsAg-negative patients treated with chemotherapy so that early commencement of antiviral therapy can be initiated before the occurrence of de novo HBV-related hepatitis.展开更多
乙型肝炎病毒（hepatitis B vlrus,HBV）表面抗原（HBsAg）作为HBV感染的主要标志之一,近年来,其定量检测开始应用于HBV感染状态评估和指导抗病毒疗效分析领域.治疗过程中血清HBsAg水平的下降速度或HBsAg和HBVDNA水平共同下降可预测CHB...乙型肝炎病毒（hepatitis B vlrus,HBV）表面抗原（HBsAg）作为HBV感染的主要标志之一,近年来,其定量检测开始应用于HBV感染状态评估和指导抗病毒疗效分析领域.治疗过程中血清HBsAg水平的下降速度或HBsAg和HBVDNA水平共同下降可预测CHB患者抗病毒治疗的持续病毒学应答及治疗结束后HBsAg的血清学转换.本研究拟对HBsAg的定量分析以及对慢乙肝患者诊疗的指导意义做一综述.展开更多
文摘Background &Aims: De novo hepatitis B virus (HBV)-related hepatitis after chemotherapy results in high morbidity and mortality. We evaluate the clinical course of de novo HBV-related hepatitis after chemotherapy. Methods: Two hundred forty-four consecutive hepatitis B surface antigen (HBsAg)-negative lymphoma patients treated with chemotherapy were followed up for a median of 12.4 (range, 0.1-65.0) months. Serially collected serum samples were analyzed for hepatitis, serum HBV DNA, and HBsAg seroreversion. Results: Eight of the 244 patients (3.3%) developed de novo HBV-related hepatitis. A 100-fold increase in serum HBV DNA preceded de novo HBV related hepatitis by a median of 18.5 (range, 12-28) weeks. All 8 patients had normal serum alanine aminotransaminase level when the 100-fold increase in serum HBV DNA occurred. Patients with de novo HBV-related hepatitis were more likely to have occult HBV infection before chemotherapy. Direct sequencing results showed that these 8 patients had de novo HBV-related hepatitis from reactivation of occult HBV infection. Three of the 8 patients with de novo HBV-related hepatitis compared with 6 of the 236 patients without de novo HBV-related hepatitis developed fulminant hepatic failure (37.5%vs 2.5%, respectively, P < .001). On multivariate Cox analysis, de novo HBV-related hepatitis was independently associated with a higher risk of fulminant hepatic failure (relative risk, 29.854; 95%confidence interval: 4.844-183.980; P < .001). Conclusions: Close surveillance for a 100-fold increase in HBV DNA is recommended for HBsAg-negative patients treated with chemotherapy so that early commencement of antiviral therapy can be initiated before the occurrence of de novo HBV-related hepatitis.
文摘乙型肝炎病毒（hepatitis B vlrus,HBV）表面抗原（HBsAg）作为HBV感染的主要标志之一,近年来,其定量检测开始应用于HBV感染状态评估和指导抗病毒疗效分析领域.治疗过程中血清HBsAg水平的下降速度或HBsAg和HBVDNA水平共同下降可预测CHB患者抗病毒治疗的持续病毒学应答及治疗结束后HBsAg的血清学转换.本研究拟对HBsAg的定量分析以及对慢乙肝患者诊疗的指导意义做一综述.
