Shimizu Daisuke, Nomura Kenichi, Matsumoto Yosuke, Ueda Kyoji, Yamaguchi Kanji, Minami Masahito, Itoh Yoshito, Horiike Shigeo, Morita Masuji, Taniwaki Masafumi, Okanoue Takeshi
Molecular Hematology and Oncology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto 602-0841, Japan.
World J Gastroenterol. 2004 Aug 1;10(15):2301-2. doi: 10.3748/wjg.v10.i15.2301.
A 62-year-old Japanese man who was positive for hepatitis B surface antigen (HBsAg) and anti-HBe antibody, underwent chemotherapy for non-Hodgkin's lymphoma (NHL). Mutations were detected in the precore region (nt1896) of HBV. Because steroid-containing regimen may cause reactivation of hepatitis B virus (HBV) and hepatitis may progress to be fulminant after its withdrawal, we administered CHO (CPA, DOX and VCR) therapy and the patient obtained complete response. However, he developed acute exacerbation of hepatitis due to HBV reactivation. Recovery was achieved with lamivudine (100 mg/d) and plasma exchange. The present case suggests that acute exacerbation of hepatitis can occur with steroid-free regimen. Because the efficacy of the prophylactic use of lamivudine has been reported and the steroid enhances curability of malignant lymphoma, the steroid containing regimen with prophylaxis of lamivudine should be evaluated further.
一名62岁的日本男性，乙肝表面抗原（HBsAg）和抗HBe抗体呈阳性，因非霍奇金淋巴瘤（NHL）接受化疗。在乙肝病毒（HBV）的前核心区（nt1896）检测到突变。由于含类固醇的治疗方案可能导致乙肝病毒（HBV）重新激活，且肝炎在停药后可能进展为暴发性肝炎，我们给予了CHO（环磷酰胺、阿霉素和长春新碱）治疗，患者获得完全缓解。然而，他因HBV重新激活而出现肝炎急性加重。通过拉米夫定（100mg/天）和血浆置换实现了康复。本病例表明，无类固醇治疗方案也可能发生肝炎急性加重。由于已有报道拉米夫定预防性使用的疗效，且类固醇可提高恶性淋巴瘤的治愈率，因此含类固醇并预防性使用拉米夫定的治疗方案应进一步评估。
