CAJ | 학술논문

目的探讨应用核苷类似物防治乙型肝炎表面抗原(HBsAg)阳性的非肝脏肿瘤患者化学治疗后乙型肝炎病毒(HBV)再激活的疗效.方法回顾性分析58例HBsAg阳性肿瘤患者的治疗及结果 .58例患者分为预防组和对照组,预防组于化疗前预防性使用核苷类似物抗HBV治疗,比较两组HBV再激活的发生情况;对照组根据化疗后使用抗HBV药物与否及使用时段,比较未用抗HBV药物者(A组)、HBV再激活后方使用抗HBV药物者(B组)和尚未发生HBV再激活即使用抗HBV药物者(C组)之间的病情发展、转归及疗效等.结果预防组22例患者中,仅3例(13.6%)发生HBV再激活,且肝炎发病程度明显轻于对照组,无重型肝炎及死亡病例.对照组36例患者中,22例(61.1%)发生HBV再激活,重型肝炎发病率(27.8%)和死亡率(16.7%)均高于预防组,肝功能损害程度亦高于预防组.在对照组中,A组5例患者均因肝功能衰竭死亡;B组13例患者中,4例发展为重型肝炎,其中1例死亡;C组18例患者中,4例出现HBV再激活,但其肝炎发病程度、病情转归、疗效均优于B组.结论 HBsAg阳性的肿瘤患者接受化疗前即预防性使用核苷类似物抗HBV治疗可有效减少HBV再激活概率.若已行化疗,及时加用核苷类似物抗HBV治疗,仍可在很大程度上减少HBV再激活的概率.即使已经出现HBV再激活,加用核苷类似物也有助于患者肝功能的恢复,改善预后.
목적 탐토응용핵감유사물방치을형간염표면항원(HBsAg)양성적비간장종류환자화학치료후을형간염병독(HBV)재격활적료효.방법 회고성분석58례HBsAg양성종류환자적치료급결과 .58례환자분위예방조화대조조,예방조우화료전예방성사용핵감유사물항HBV치료,비교량조HBV재격활적발생정황;대조조근거화료후사용항HBV약물여부급사용시단,비교미용항HBV약물자(A조)、HBV재격활후방사용항HBV약물자(B조)화상미발생HBV재격활즉사용항HBV약물자(C조)지간적병정발전、전귀급료효등.결과 예방조22례환자중,부3례(13.6%)발생HBV재격활,차간염발병정도명현경우대조조,무중형간염급사망병례.대조조36례환자중,22례(61.1%)발생HBV재격활,중형간염발병솔(27.8%)화사망솔(16.7%)균고우예방조,간공능손해정도역고우예방조.재대조조중,A조5례환자균인간공능쇠갈사망;B조13례환자중,4례발전위중형간염,기중1례사망;C조18례환자중,4례출현HBV재격활,단기간염발병정도、병정전귀、료효균우우B조.결론 HBsAg양성적종류환자접수화료전즉예방성사용핵감유사물항HBV치료가유효감소HBV재격활개솔.약이행화료,급시가용핵감유사물항HBV치료,잉가재흔대정도상감소HBV재격활적개솔.즉사이경출현HBV재격활,가용핵감유사물야유조우환자간공능적회복,개선예후.
Objective To investigate the efficacy of nucleosides as a prophylactic agent against reactivation of hepatitis B virus ( HBV) in HBsAg-positive patients with non-hepatic tumors after chemotherapy. Methods Fifty-eight patients with non-hepatic tumors were divided into prevention group and control group.The patients of prevention group received nucleosides as a prophylactic agent before chemotherapy and were compared with the control ones about the clinical manifestation of HBV reactivation. Then, the patients of the control group were divided into three groups according to antiviral drugs, use or not and time of the use.The patients having HBV reactivation but never received nucleosides were included in the group A, the patients receiving nucleosides after having HBV reactivation were divided into the group B, and the patients receiving nucleosides before HBV reactivation were divided into tke group C. The progression, prognosis and curative effect among the three groups were compared.Results The rate of HBV reactivation, incidence of severe hepatitis, mortality rate of the control group (61. 1% , 27. 8% , 16.1% ) were significantly higher than those of the prevention group (13.6% , 0, 0) , and liver dysfunction was more serious than that in the prevention group. In the control group, all the 5 patients of group A died of liver failure.Of the 13 patients in the group B, 4 cases suffered from severe hepatitis and 1 of them died of the disease. Of the 18 patients in the group C, 4 cases suffered from HBV reactivation, but the clinical manifestation was milder than that of the group B. Conclusion Nucleosides can be used as a prophylactic measure to prevent HBV reactivation. If chemotherapy had begun, the use of nucleosides may reduce the risk of HBV reactivation. Even if patients had suffered from HBV reactivation, the use of nucleosides may still help the recovery of liver function and improve prognosis.