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肝病

癌症化疗致乙型肝炎病毒再激活

作者:曹利 来源: 日期:2015-05-21
导读

乙型肝炎病毒再激活(HBVr)是癌症化疗过程中的严重并发症。然而,乙肝病毒筛查的利用不足和抗病毒药物预防治疗不充分利用已屡有报道。

关键字: 化疗 | 乙肝病毒 | 激活 |

乙型肝炎病毒再激活(HBVr)是癌症化疗过程中的严重并发症。然而,乙肝病毒筛查的利用不足和抗病毒药物预防治疗不充分利用已屡有报道。

作者为了在癌症化疗期间捕获与HBVr相关的经验,以电子版形式向美国肝病研究协会的成员分发带有30个问题的问卷。调查问卷详细规定了诊断标准,并收集关于乙肝病毒筛查,抗病毒药物预防和临床结果的信息。99名受访者报导有188例患者符合HBV再激活的诊断标准。41名受访者是在美国以外的地方工作,大多数是肝病学者(N = 71)或胃肠病学者(N = 12)。120例患者患有血液系统恶性肿瘤,其中88例患者(70%)有淋巴瘤。75例患者(40%)有乙型肝炎表面抗原(HBsAg)和乙型肝炎核心抗原抗体(抗-HBc),另外24例患者(13%)只有HBsAg。预防性抗病毒疗法仅在18例患者(10%)中被报道使用。52例(41%)患有血液学恶性肿瘤的患者和41例患有实体瘤的患者中有26(63%)例患者(p = 0.01)的化疗被中断。利妥昔单抗治疗的患者(n = 66)需要更频繁的住院治疗(P = 0.04),但他们的总生存率和不使用利妥昔单抗治疗的个体并没有差异。整体上因肝功能衰竭造成死亡的病例数有43例(23%)。预防性抗病毒治疗一般都是应用在那些癌症化疗开始之前就感染乙肝病毒的大部分患者中。这种情况的原因还需要进一步的探索,因为再激活会导致严重不良结果,然而这些是可以预防的。

编译自:Hepatitis B Reactivation During Cancer Chemotherapy,J Viral Hepat.2015;22(3):346-352.

文献原文:

Abstract

Hepatitis B virus reactivation (HBVr) can be a serious complication of cancer chemotherapy. However, underutilization of HBV screening and secondary underutilization of antiviral prophylaxis have been frequently reported. The authors electronically distributed a 30-point questionnaire to members of the American Association for the Study of Liver Diseases to capture experiences with HBVr during cancer chemotherapy. The questionnaire specified diagnostic criteria and collected information on HBV screening, antiviral prophylaxis and clinical outcomes. Ninety-nine respondents reported 188 patients who met the criteria for HBV reactivation. Forty-one practised outside the United States, and most were hepatologists (n = 71) or gastroenterologists (n = 12). One hundred and twenty-six patients had haematologic malignancies, of which 88 (70%) had lymphoma. Seventy-five patients (40%) had screening for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc), and an additional 24 patients (13%) had HBsAg screening alone. Prophylactic antiviral therapy was reported in only 18 patients (10%). Chemotherapy was interrupted in 52 patients (41%) with haematologic malignancies and 26 of 41 patients (63%) with solid tumours (P = 0.01). Rituximab-treated patients (n = 66) required hospitalization more frequently (P = 0.04), but their overall survival did not differ from individuals not treated with rituximab. Death due to liver failure was reported in 43 patients overall (23%). Underutilization of prophylactic antiviral therapy occured in a substantial number of patients who were found to be HBV infected prior to the initiation of cancer chemotherapy. The reasons for this need further exploration because reactivation results in serious yet preventable outcomes.

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