Su Wen-Pin, Wen Chi-Chung, Hsiung Chao-A, Su Ih-Jen, Cheng Ann-Lii, Chang Ming-Chih, Tsao Chao-Jung, Kao Woei-Yao, Uen Wu-Ching, Hsu Chiun, Hsu Chih-Hung, Lu Yen-Shen, Tien Hwei-Fan, Chao Tsu-Yi, Chen Li-Tzong, Whang-Peng Jacqueline, Chen Pei-Jer
Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10016, Taiwan, China.
World J Gastroenterol. 2005 Sep 14;11(34):5283-8. doi: 10.3748/wjg.v11.i34.5283.
To investigate the long-term consequences of chemotherapy-related HBV reactivation in patients with lymphoma.
This study was based on the database of published prospective study evaluating HBV reactivation in HBV lymphoma patients during chemotherapy. Deteriorated liver reserve (DLR) was defined as development of either one of the following conditions during follow-up: (1) newly onset parenchyma liver disease, splenomegaly or ascites without evidence of lymphoma involvement; (2) decrease of the ratio (albumin/globulin ratio) to less than 0.8 or increase of the ratio of INR of prothrombin time to larger than 1.2 without evidence of malnutrition or infection. Liver cirrhosis was diagnosed by imaging studies.
A total of 49 patients were included. The median follow-up was 6.2 years (range, 3.9-8.1 years). There were 31 patients with and 18 patients without HBV reactivation. Although there was no difference of overall survival (OS) and chemotherapy response rate between the two groups, DLR developed more frequently in patients with HBV reactivation (48.4% vs 16.7%; P = 0.0342). Among the HBV reactivators, HBV genotype C was associated with a higher risk of developing DLR (P = 0.0768) and liver cirrhosis (P = 0.003). Four of five patients with sustained high titer of HBV DNA and two of three patients with multiple HBV reactivation developed DLR. Further, patients with a sustained high titer of HBV DNA had the shortest OS among the HBV reactivators (P = 0.0000). No patients in the non-HBV reactivation group developed hepatic failure or liver cirrhosis.
Chemotherapy-related HBV reactivation is associated with the long-term effect of deterioration of hepatic function.
探讨淋巴瘤患者化疗相关乙肝病毒（HBV）再激活的长期后果。
本研究基于已发表的前瞻性研究数据库，该研究评估了化疗期间HBV阳性淋巴瘤患者的HBV再激活情况。肝脏储备功能恶化（DLR）定义为随访期间出现以下任何一种情况：（1）新发实质性肝病、脾肿大或腹水，且无淋巴瘤累及证据；（2）白蛋白/球蛋白比值降至低于0.8或凝血酶原时间国际标准化比值（INR）升至大于1.2，且无营养不良或感染证据。通过影像学检查诊断肝硬化。
共纳入49例患者。中位随访时间为6.2年（范围3.9 - 8.1年）。有31例患者发生HBV再激活，18例患者未发生HBV再激活。尽管两组患者的总生存期（OS）和化疗反应率无差异，但HBV再激活患者DLR的发生频率更高（48.4%对16.7%；P = 0.0342）。在HBV再激活患者中，HBV基因型C与发生DLR的较高风险相关（P = 0.0768）以及肝硬化（P = 0.003）。五例HBV DNA持续高滴度患者中有四例以及三例多次发生HBV再激活的患者中有两例发生了DLR。此外，在HBV再激活患者中，HBV DNA持续高滴度的患者总生存期最短（P = 0.0000）。非HBV再激活组无患者发生肝衰竭或肝硬化。
化疗相关HBV再激活与肝功能恶化的长期影响相关。
