【摘要】 目的评价预防性抗病毒治疗对乙型病毒性肝炎表面抗原（HBsAg）阳性非霍奇金淋巴瘤（NHL）患者免疫化疗后乙型病毒性肝炎病毒（HBV）再激活的影响及相关因素。方法回顾性分析2010年至2018年北京大学第三医院血液科收治的1003例NHL患者,其中71例HBsAg阳性NHL患者同时接受预防性抗病毒治疗及免疫化疗。根据是否HBV再激活分为未激活组61例和激活组10例。比较2组患者的临床特点、预防性抗病毒方案及免疫化疗对HBV再激活的影响。结果免疫化疗后,未激活组与激活组的平均谷丙转氨酶分别为（20.31±12.77）和（262.80±100.08） U·L^-1,谷草转氨酶分别为（25.77±18.74）和（100.20±95.67） U·L^-1,总胆红素分别为（13.63±8.46）和（41.12±35.41）μmol·L^-1,差异均有统计学意义（均P <0.05）。激活组化疗前及化疗后HBV-DNA分别为（2.82±1.59）和（4.14±1.57） lg U·mL^-1,差异有统计学意义（P <0.05）。不同病理分型及临床分期NHL患者HBV再激活差异均无统计学意义（均P> 0.05）。拉米夫定（LAM）单药预防及恩替卡韦（ETV）单药预防后HBV再激活发生率分别为33.3%和8.7%,差异有统计学意义（P <0.05）。未应用利妥昔单抗及应用利妥昔单抗患者HBV再激活发生率分别为28.6%和10.3%,差异无统计学意义（P> 0.05）。6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3例,肝衰竭死亡1例。结论 HBSAg阳性NHL患者接受免疫化疗时需预防性抗病毒治疗,不同病理分型及临床分期NHL患者HBV再激活无显著差异; ETV较LAM能更有效地降低HBV再激活发生率,但仍有中度风险。更多还原

【Abstract】 Objective To evaluate the effect of prophylactic antiviral therapy on hepatitis B virus（HBV） reactivation in patients with hepatitis B surface antigen positive（HBsAg-positive） non-Hodgkin’s lymphoma（NHL） after immunochemotherapy and its related factors.Methods A retrospective analysis was made of 1003 NHL patients admitted to the hematology department of the third hospital of peking university from2010 to 2018.71 HBsAg positive NHL patients received both prophylactic antiviral therapy and immunochemotherapy.According to whether HBV is reactivated or not,the 71 HBsAg positive NHL patients were divided into non-reactivation group（61 cases） and reactivation group （10 cases）.The clinical characteristics,prophylactic antiviral therapy regimens and the effects of Immunochemotherapy on HBV reactivation were compared between the two groups.Results After immunochemotherapy,the average glutamic-pyruvic transaminase of the non-reactivated group and the reactivated group were（20.31 ± 12.77） and（262.80 ± 100.08） U·L^-1,glutamic oxaloacetic transaminase were（25.77 ± 18.74） and（100.20 ± 95.67）U·L^-1,total bilirubin were（13.63 ± 8.46） and（41.12 ± 35.41） μmol·L^-1,the differences were statistically significant（all P < 0.05）.HBV-DNA levels in the reactivation group before and after immunochemotherapy were（2.82 ± 1.59） and（4.14 ± 1.57） lg U·mL^-1 with significant difference（P < 0.05）.There was no significant difference in HBV reactivation among NHL patients with different pathological types and clinical stages.The incidence of HBV reactivation prophylaxis with lamivudine（LAM） alone and those with entecavir（ETV） alone were 33.3% and 8.7% with significant difference（P < 0.05）.The incidence of HBV reactivation in patients without rituximab and those with rituximab were 28.6% and 10.3% without significant difference（P > 0.05）.Six patients were discontinued immunochemotherapy or rituximab therapy due to HBV reactivation,including 3 cases of HBV reactivation hepatitis and1 case died of hepatic failure.Conclusion Prophylactic antivirus therapy was necessary for HBsAg positive NHL patients undergoing chemotherapy.There was no significant difference in HBV reactivation among different pathological types and clinical stages of NHL.ETV was more effective than LAM in reducing the incidence of HBV reactivation,but ETV prophylactic antivirus therapy still had a moderate risk of HBV reactivation.更多还原