Sato Kazuya
Division of Gastroenterology, Dept. of Medicine, Asahikawa Medical University, Asahikawa, Hokaido, Japan.
Gan To Kagaku Ryoho. 2011 Feb;38(2):161-8.
Immunosuppressive treatments, such as rituximab-containing chemotherapy or stem cell transplantation, have been widely performed following recent developments in cancer therapy. Immunosuppressive therapy or chemotherapy(IS/CT)-induced reactivation of the hepatitis B virus(HBV)in HBsAg-positive HBV-carriers is a well-known phenomenon. It has recently been demonstrated that HBV-reactivation also occurs in HBV-resolved patients who are negative for HBsAg, and positive for HBsAb and/or HBcAb. This is because de novo hepatitis B, which occurs in HBV-resolved patients with a recurrence of HBV hepatitis, have a high risk of fulminant hepatitis with an extremely poor prognosis. In this regard, prevention a guideline for IS/ CT-induced HBV-reactivation was established in Japan. However, the incidence of, and risk factors for, IS/CT-induced HBV- reactivation in HBV-resolved patients in Japan has not yet been elucidated. We retrospectively analyzed IS/CT-induced HBV- reactivation in resolved HBV-patients with hematological disorders in our hospital. Reactivation occurred in 5. 0%patients(5/ 101), and administration of more than 2 regimens for the hematological disorder was identified as an independent risk factor for HBV-reactivation in multivariate analysis. Further investigation of the risk factors for HBV-reactivation and the efficacy of the guideline should be performed during multicenter prospective study.
随着癌症治疗领域的最新进展，免疫抑制治疗，如含利妥昔单抗的化疗或干细胞移植，已被广泛应用。免疫抑制治疗或化疗（IS/CT）诱导的乙肝表面抗原（HBsAg）阳性乙肝携带者体内乙肝病毒（HBV）再激活是一种众所周知的现象。最近有研究表明，HBV再激活也发生在HBsAg阴性、乙肝表面抗体（HBsAb）和/或乙肝核心抗体（HBcAb）阳性的乙肝已治愈患者中。这是因为乙肝已治愈患者中发生的新发乙型肝炎，即HBV肝炎复发，有发生暴发性肝炎的高风险，预后极差。在这方面，日本制定了预防IS/CT诱导的HBV再激活的指南。然而，日本乙肝已治愈患者中IS/CT诱导的HBV再激活的发生率和危险因素尚未阐明。我们对我院血液系统疾病乙肝已治愈患者中IS/CT诱导的HBV再激活进行了回顾性分析。5.0%的患者（5/101）发生了再激活，多因素分析确定针对血液系统疾病使用超过2种治疗方案是HBV再激活的独立危险因素。在多中心前瞻性研究中应进一步调查HBV再激活的危险因素以及该指南的有效性。
