Law Joanna K, Ho Jin K, Hoskins Paul J, Erb Siegfried R, Steinbrecher Urs P, Yoshida Eric M
Department of Medicine, University of British Columbia, Vancouver, Canada.
Leuk Lymphoma. 2005 Jul;46(7):1085-9. doi: 10.1080/10428190500062932.
In the absence of prophylaxis, the reactivation of hepatitis B in oncology patients who are hepatitis B carriers is a well-known and often fatal complication of chemotherapy. The current recommendations in Canada and the USA are that patients who are positive for hepatitis B surface antigen (HBsAg) receive antiviral prophylaxis prior to chemotherapy. We report a 67-year-old man with B-cell lymphoma who developed hepatitis B reactivation following chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone and rituximab. Pre-chemotherapy, the patient was negative for HBsAg, positive for hepatitis B core antibody (anti-HBc) and weakly positive for hepatitis B surface antibody. Despite treatment with lamivudine, the patient died of fulminant hepatic failure. Our experience indicates that patients who are negative for HBsAg but positive for anti-HBc are still at risk for reactivation of latent hepatitis B during and after chemotherapy and may be considered for prophylaxis.
在未进行预防的情况下，乙肝携带者肿瘤患者中乙肝再激活是化疗一种广为人知且往往致命的并发症。加拿大和美国目前的建议是，乙肝表面抗原（HBsAg）呈阳性的患者在化疗前接受抗病毒预防。我们报告一名67岁的B细胞淋巴瘤男性患者，在用环磷酰胺、阿霉素、长春新碱、泼尼松和利妥昔单抗化疗后发生了乙肝再激活。化疗前，患者HBsAg呈阴性，乙肝核心抗体（抗-HBc）呈阳性，乙肝表面抗体呈弱阳性。尽管接受了拉米夫定治疗，患者仍死于暴发性肝衰竭。我们的经验表明，HBsAg阴性但抗-HBc阳性的患者在化疗期间和化疗后仍有潜在乙肝再激活的风险，可能需要考虑进行预防。
