拉米夫定预防乙型肝炎病毒再激活的临床分析

摘要

目的 探讨使用免疫抑制剂和(或)细胞毒性化疗药物的乙型肝炎病毒(HBV)感染者HBV再激活的发生率及其抗病毒治疗的疗效.方法 预防组33例患者在接受免疫抑制剂和(或)细胞毒性化疗药物治疗前予拉米夫定(LAM) 100 mg/d并持续至治疗结束后6个月,对照组39例未接受预防治疗,观察两组患者HBV再激活的发生率和临床表现.统计学分析采用两种属性独立性x 2检验,进行危险比评估.结果 预防组HBV再激活发生率为12.12％(4/33),对照组为76.92％(30/39),预防组HBV再激活发生率低于对照组,x 2 =10.35,P=0.001,差异有统计学意义；对照组HBV再激活后患者死亡率、肝炎发生率高于预防组,差异有统计学意义；两组药物性肝损伤、重型肝炎的发病率差异无统计学意义,对照组中有9例进展为重型肝炎,均死亡.结论 使用免疫抑制剂和(或)细胞毒性化疗药物的HBV感染者预防性使用LAM可以有效防止HBV再激活,降低病死率.所有需要使用免疫抑制剂和(或)化疗药物的患者在用药前须进行常规HBV筛查.%Objective To investigate the efficacy of lamivudine (LAM) as a prophylactic agent against the reactivation of hepatitis B virus( HBV) in patients with HBV infection and undergoing immunosuppressive therapy and/or chemotherapy,and to evaluate the role of LAM against HBV reactivation. Methods Thirty-three patients of the preventive group received LAM as a prophylactic agent before immunosuppressive and/or chemotherapy. Thirty-nine patients of the control group were enrolled in the study. The characteristics of HBV reactivation were investigated. Results After chemotherapy and/or immunosuppressive treatment,only 12. 12%(4/33)of the preventive group were suffered from HBV reactivation. Nine patients in the control group were dead of liver failure. Conclusion HBV can be activated in cytotoxic chemotherapy and/or immunosuppressed patients. LAM should be used in early phase to prevent HBV reactivation.