Hospital Vall d'Hebron, Liver Unit, CIBERehd Institute Carlos III, Paseo de Vall d'Hebron, 08035 Barcelona, Spain.
J Hepatol. 2009 Dec;51(6):1091-6. doi: 10.1016/j.jhep.2009.07.012. Epub 2009 Jul 30.
BACKGROUNDS/AIMS: Hepatitis B virus (HBV) reactivation following treatment with rituximab has been reported in patients with either HBsAg-positive, or HBsAg-negative and anti-HBc positive infection. Patients with severe reactivation often have a fatal outcome despite treatment with lamivudine. The use of entecavir has not been reported in patients with severe HBV reactivation.
We present a case of a HBsAg-negative patient diagnosed with chronic lymphocytic leukemia who received a chemotherapeutic regimen that included rituximab, who subsequently presented with severe HBV reactivation with ascites, jaundice and coagulopathy and was treated with entecavir. A review of the literature and underlying HBV associated mutations are discussed.
Entecavir produced a rapid and sustained suppression of HBV that was associated with rapid clinical improvement without any side effects.
Entecavir is an efficacious and safe treatment for severe HBV reactivation.
背景/目的：在接受利妥昔单抗治疗后，HBV 会发生再激活，这在 HBsAg 阳性或 HBsAg 阴性和抗 HBc 阳性感染的患者中均有报道。尽管接受了拉米夫定治疗，严重再激活的患者通常仍有致命结局。在严重 HBV 再激活的患者中，尚未报道使用恩替卡韦。
我们报告了一例 HBsAg 阴性的慢性淋巴细胞白血病患者，该患者接受了包括利妥昔单抗在内的化疗方案，随后出现腹水、黄疸和凝血功能障碍的严重 HBV 再激活，并接受了恩替卡韦治疗。我们对文献进行了回顾，并讨论了潜在的 HBV 相关突变。
恩替卡韦能迅速、持续地抑制 HBV，与快速的临床改善相关，且无任何副作用。
恩替卡韦是治疗严重 HBV 再激活的有效且安全的药物。
