乳腺癌患者化疗后乙肝病毒再激活及拉米夫定预防性应用的临床研究

目的:探讨化疗引起的乳腺癌患者肝功能损害与乙肝病毒(HBV)感染的相关性及抗病毒治疗在预防化疗引起的HBV再激活中的作用。方法:2006年3月-2010年10月在武汉市第三医院接受化疗的病理确诊为乳腺癌患者(包括术后辅助化疗)为研究对象,比较HBs Ag阴性138例和HBs Ag阳性50例患者化疗后肝功能损害的发生情况,并分析在HBs Ag阳性患者中,预防性使用(21例)与未预防性使用(27例)抗病毒药物拉米夫定后乙肝病毒再激活率的差异。结果:化疗后出现肝功能损害的乳腺癌患者中,HBs Ag阳性患者(31.25%)与HBs Ag阴性患者(16.67%)所占比例的差异有统计学意义(P<0.001)。化疗前预防性使用拉米夫定(4.62%)与未预防性使用(25.93%)拉米夫定,患者出现HBV再激活率的差异亦有统计学意义(P<0.01)。结论:乳腺癌患者化疗后,HBs Ag阳性患者较HBs Ag阴性患者更易出现肝功能损害,预防性使用核苷类似物抗病毒药物拉米夫定,可明显降低乳腺癌合并乙肝患者化疗后HBV再激活肝炎的发生。

Clinical Study of HBV Reactivation and Prophylactic Application of Lamivudine in Breast Cancer Patients after Chemotherapy

Objective:To investigate the correlation between liver function damage caused by chemotherapy and hepatitis B virus (HBV) infection in patients with breast cancer and to evaluate the effect of antiviral therapy in the prevention of chemotherapy-originated HBV reactivation.Methods:A total of 188 breast cancer patients who were diagnosed via pathology and recieved chemotherapy, including postoperative adjuvant chemotherapy, in the Third Hospital of Wuhan from March 2006 to October 2010 were selected as the object of study. The post-chemotherapy liver damage situations of 138 HBsAg-negative and 50 HBsAg-positive patients were compared. And the difference in HBV reactivation rate in HBsAg-positive patients was analyzed and compared between the group (21 cases) that used antiviral drug lamivudine prophylacticly and the group(27 cases) which used no lamivudine.Results:The incidence of liver function impairment after chemotherapy was 31.25%(15/48) in the HBsAg-positive patients, and 16.67%(22/132) in the HBsAg-negative patients. The difference was statistically significant(P<0.001). In the HBsAg-positive group, the HBV reactivation rate was 4.62%(1/21) in patients who were given prophylactic lamivudine, and was 25.93%(7/27) in patients who received no prophylactic antivirus treatment. The difference was statistically significant (P<0.01).Conclusion:After chemotherapy, HBsAg-positive breast cancer patients are more prone to liver function damage than HBsAg-negative patients, prophylactic use of nucleoside analogs antiviral drug lamivudine can significantly reduce HBV reactivative hepatitis in breast cancer patients with type B hepatitis.