抗-HBc阳性淋巴瘤患者化疗期间应用拉米夫定抗病毒治疗预防肝功能损害和HBV激活

摘要

目的 探讨拉米夫定对乙型肝炎核心抗体(抗-HBc)阳性淋巴瘤患者化疗后病毒激活和肝功能损害的预防作用.方法 79例HBsAg(-)而抗-HBc(+)的淋巴瘤患者分为拉米夫定治疗组(37例)和对照组(42例).两组患者均进行联合化疗,期间观察肝功能损害和HBV激活情况,并用SSPS 13.0软件进行统计学分析.结果 预防性应用拉米夫定治疗的37例患者中,化疗后出现肝功能损害Ⅰ～Ⅱ期11例(29.7%),Ⅲ～Ⅳ期2例(5.4%),HBV激活2例(5.4%),而且这2例患者均出现HBV YMDD基因变异.42例化疗时未进行抗病毒治疗的患者中,化疗后出现肝功能损害Ⅰ～Ⅱ期19例(45.2%),Ⅲ～Ⅳ期7例(16.7%),HBV激活12例(28.6%),与拉米夫定治疗组比较差异均具有统计学意义(χ2值分别为79.0、8.7和79.0,P值＜0.05或＜0.01).结论 HBsAg(-)而抗-HBc(+)淋巴瘤患者进行化疗时预防性应用拉米夫定可以减少肝脏损害的发生和HBV的激活.%Objective To evaluate the effectiveness of lamivudine in preventing liver damages and HBV DNA reactivation in anti-HBc positive lymphoma patients after chemotherapy.Methods Seventy-nine lymphoma patients who were negative in HBsAg and positive in anti-HBc were enrolled and were divided into lamivudine group (n=37) and control group (n=42).Both groups received chemotherapy.Liver damages and HBV reactivation were observed, and the data were analyzed with software SPSS 13.0.Results In lamivudine group, liver damages Ⅰ or Ⅱ was observed in 11 patients (11/37, 29.7%), and liver damages Ⅲ or Ⅳ was observed in 2 (2/37, 5.4%); two patients (2/37, 5.4%) developed HBV reactivation, and both of them had HBV YMDD mutations.In control group, 19 (19/42, 45.2%) patients experienced liver damages Ⅰ or Ⅱ, 7 (7/42, 16.7%) experienced liver damages Ⅲ or Ⅳ; 12 (12/42, 28.6%) patients experienced HBV reactivation, the differences between the two groups were of statistical significance (χ2=79.0, 8.7 and 79.0, P ＜ 0.05 or ＜ 0.01).Conclusion Lamivudine can reduce liver damages and HBV reactivation in HBsAg negative and anti-HBc positive patients with lymphoma during chemotherapy.