Stange M A, Tutarel O, Pischke S, Schneider A, Strassburg C P, Becker T, Barg-Hock H, Bastürk M, Wursthorn K, Cornberg M, Ott M, Greten T F, Manns M P, Wedemeyer H
Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.
Z Gastroenterol. 2010 Feb;48(2):258-63. doi: 10.1055/s-0028-1109782. Epub 2010 Feb 2.
Hepatitis B virus reactivation during immunosuppressive therapies can lead to liver failure with very limited treatment options available. We report here on two cases of severe hepatitis B reactivation during chemotherapy including rituximab for B cell lymphoma which were treated with liver or liver-cell transplantation. Liver function was normal and HBV infection was unknown in both patients before chemotherapy was started. Impaired liver function became apparent after 4 and 6 courses of chemotherapy, respectively, and both patients experienced fulminant hepatic failure despite antiviral treatment with lamivudine or entecavir. Patient A underwent liver transplantation after documentation of complete remission of the lymphoma and survived without any evidence for hepatitis B recurrence. Patient B received 4 courses of hepatocyte transplantation but did not survive. These cases underline the importance of anti-HBc screening in patients receiving immunosuppressive treatments in particular when rituximab is given. Pre-emptive antiviral treatments should be administered since delayed antiviral treatment is frequently unable to prevent liver failure.
免疫抑制治疗期间的乙型肝炎病毒再激活可导致肝衰竭，而可用的治疗选择非常有限。我们在此报告两例化疗期间严重乙型肝炎再激活的病例，包括用利妥昔单抗治疗B细胞淋巴瘤，这两例患者接受了肝移植或肝细胞移植。在开始化疗前，两名患者的肝功能均正常且未知有HBV感染。分别在4个和6个疗程的化疗后肝功能明显受损，尽管用拉米夫定或恩替卡韦进行了抗病毒治疗，两名患者均发生了暴发性肝衰竭。患者A在淋巴瘤完全缓解得到证实后接受了肝移植，存活且无任何乙型肝炎复发的证据。患者B接受了4个疗程的肝细胞移植，但未存活。这些病例强调了在接受免疫抑制治疗的患者中进行抗-HBc筛查的重要性，特别是在给予利妥昔单抗时。应进行抢先抗病毒治疗，因为延迟抗病毒治疗常常无法预防肝衰竭。
