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目的探讨淋巴瘤患者化学治疗(化疗)前乙型肝炎病毒(HBV)感染的筛查率和化疗后HBV的激活情况及其影响因素。方法对2010年6月-2012年7月于四川大学华西医院行化疗的449例淋巴瘤初治患者的HBV感染筛查情况进行回顾性分析。结果淋巴瘤患者化疗前HBV筛查率为86.2%,转氨酶水平升高比转氨酶正常的患者化疗前的HBV筛查率更高(OR=2.509,P=0.040)。乙型肝炎病毒表面抗原(HBs Ag)阳性的患者中,化疗后HBV激活率为16.1%(9/56),使用利妥昔单抗的患者HBV激活率更高(29.2%、6.3%,P=0.030),抗病毒治疗能明显降低HBV激活率(12.0%、50.0%,P=0.046)。HBs Ag阴性/乙型肝炎核心抗体阳性的患者中发生2例HBV激活。结论 HBV激活在合并HBV感染的淋巴瘤患者中常见,尤其是对于使用利妥昔单抗治疗的患者。淋巴瘤患者化疗前应常规筛查HBV,预防性抗病毒治疗是降低HBV激活率的有效措施。
Objective To investigate the screening rate of hepatitis B virus (HBV) infection in patients with lymphoma prior to chemotherapy (chemotherapy) and the activation of HBV after chemotherapy and its influencing factors. Methods A retrospective analysis of HBV infection screening among 449 lymphoma-naive patients who underwent chemotherapy in West China Hospital of Sichuan University from June 2010 to July 2012 was performed. Results Before chemotherapy, the screening rate of HBV in patients with lymphoma was 86.2%. The level of aminotransferase in patients with lymphoma was higher than that before chemotherapy in patients with normal aminotransferase (OR = 2.509, P = 0.040). Among HBsAg-positive patients, the HBV activation rate after chemotherapy was 16.1% (9/56), and those with rituximab were higher (29.2%, 6.3%, P = 0.030). Antiviral therapy can significantly reduce the rate of HBV activation (12.0%, 50.0%, P = 0.046). Two cases of HBV activation occurred in HBsAg negative / hepatitis B core antibody positive patients. Conclusion HBV activation is common in patients with HBV-infected lymphoma, especially in patients treated with rituximab. Lymphoma patients should be routinely screened for HBV before chemotherapy, prophylactic antiviral therapy is an effective measure to reduce the rate of HBV activation.