Ohtsu T, Sai T, Oka M, Sugai Y, Tobinai K
Department of Internal Medicine, Iwaki Kyoritsu General Hospital.
Jpn J Clin Oncol. 1991 Oct;21(5):360-5.
Among 262 inpatients with hematologic diseases who were referred for chemotherapy or immunosuppressive therapy between January, 1985, and December, 1989, nine (3.4%) patients, including two with Hodgkin's disease (HD), three with acute myeloblastic leukemia, one with chronic myelogenous leukemia, two with multiple myeloma and one with aplastic anemia, were found to be hepatitis B virus (HBV) carriers before their chemotherapy began. All six HBV carriers who received chemotherapy containing glucocorticoid showed mild-to-moderate elevations in serum transaminase levels after the chemotherapy. Five showed a rise in titer of the hepatitis B surface antigen, HBsAg. In contrast, three HBV carriers not receiving glucocorticoid showed no change in serum transaminase after chemotherapy. One HBV carrier with HD suffered from severe icteric hepatitis after the withdrawal of multiagent chemotherapy containing glucocorticoid. The HBV-DNA polymerase rose markedly and was accompanied by a marked rise in titer of HBsAg. The results warn us to keep in mind the possibility of glucocorticoid inducing an activation of HBV infection, which may result in severe hepatitis in some HBV carriers. Although further investigation is required, it is recommended that HBsAg-positive patients with hematologic malignancies should, if possible, be treated without glucocorticoid.
在1985年1月至1989年12月期间因化疗或免疫抑制治疗而转诊的262例血液病住院患者中，有9例（3.4%）在化疗开始前被发现为乙型肝炎病毒（HBV）携带者，其中包括2例霍奇金病（HD）、3例急性髓细胞白血病、1例慢性粒细胞白血病、2例多发性骨髓瘤和1例再生障碍性贫血。所有6例接受含糖皮质激素化疗的HBV携带者在化疗后血清转氨酶水平均有轻度至中度升高。5例乙肝表面抗原（HBsAg）滴度升高。相比之下，3例未接受糖皮质激素的HBV携带者化疗后血清转氨酶无变化。1例HD患者在停用含糖皮质激素的联合化疗后发生了严重黄疸型肝炎。HBV-DNA聚合酶显著升高，并伴有HBsAg滴度显著升高。结果提醒我们要牢记糖皮质激素诱导HBV感染激活的可能性，这可能导致一些HBV携带者发生严重肝炎。尽管需要进一步研究，但建议HBsAg阳性的血液系统恶性肿瘤患者尽可能在无糖皮质激素的情况下进行治疗。
