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目的回顾性分析核苷类似物(NAs)对恶性肿瘤合并慢性乙肝病毒(HBV)携带者化疗后HBV再激活的治疗效果及化疗前抗病毒用药对HBV再激活的预防作用。方法收集2006年1月―2011年12月本院住院肿瘤患者中进行细胞毒性药物化疗的非活动性乙肝表面抗原(HBsAg)携带者病例。对照组为规范细胞毒性药物化疗,观察化疗后乙肝病毒活跃情况和肝功能损害;预防组在化疗前1~2周使用NAs,根据具体情况持续使用NAs 6~12月,观察HBV再激活的情况和临床表现。结果共收集227例患者,化疗期间共出现67例(29.5%)HBV再激活。对照组102例患者中56例(54.9%)出现HBV再激活,其中19例患者发展为重型肝炎,9例死亡,2例转至外院行活体肝移植;预防组125例患者在使用NAs后有11例(8.8%)出现HBV再激活,其中5例发展为重型肝炎,2例死亡。两组再激活发生率有非常显著差异(χ2=57.4,P<0.001)。结论恶性肿瘤合并非活动性HBsAg携带者在接受细胞毒性药物化疗前应及时使用NAs抗病毒治疗,以减少HBV再激活的发生,从而改善临床预后。
Objective To retrospectively analyze the therapeutic effect of nucleoside analogs (NAs) on HBV reactivation after chemotherapy in patients with malignant tumor and chronic hepatitis B virus (HBV) and the preventive effect of antiviral drugs before chemotherapy on HBV reactivation. Methods We collected cases of inactive hepatitis B surface antigen (HBsAg) carriers who underwent cytotoxic chemotherapy in hospitalized oncology patients from January 2006 to December 2011. The control group was given standard chemotherapy of cytotoxic drugs to observe the activity of hepatitis B virus and the damage of liver function after chemotherapy. The prophylaxis group used NAs one to two weeks before chemotherapy and continued to use NAs from December to December according to the specific conditions, and observed the reactivation of HBV And clinical manifestations. Results Totally 227 patients were recruited. A total of 67 (29.5%) HBV reactivations occurred during chemotherapy. HBV reactivation occurred in 56 (54.9%) of the 102 patients in the control group, of whom 19 developed severe hepatitis, 9 died and 2 were transferred to living-donor liver transplantations outside the hospital; 125 patients in the prophylaxis group had NAC Reactivation of HBV occurred in 11 patients (8.8%), of which 5 developed severe hepatitis and 2 died. There was a significant difference in reactivation rates between the two groups (χ2 = 57.4, P <0.001). Conclusion In patients with malignant tumor complicated with inactive HBsAg carriers, NAs antiviral therapy should be used in time before receiving cytotoxic drug chemotherapy to reduce the occurrence of HBV reactivation and improve the clinical prognosis.