Popović Nataša, Stojković-Švirtlih Neda, Simonović-Babić Jasmina, Boričić Ivan, Tomanović Nada, Mitrović Nikola, Delić Dragan
Srp Arh Celok Lek. 2011 Nov-Dec;139(11-12):824-7. doi: 10.2298/sarh1112824p.
Reactivation of chronic hepatitis B virus (HBV) infection often occurs in hepatitis B surface antigen (HBsAg) positive patients undergoing immunosuppressive or chemotherapy, but can also occur in HBsAg negative, anti-HB core positive patients. Treatment of HBV reactivation with lamivudin results in favourable outcome in the majority of patients. The aim of the authors was to show the effect of lamivudin therapy to HBV reactivation caused by immunosuppressive therapy.
The first patient was a 35-year-old woman with chronic hepatitis B virus infection who underwent prednisolone therapy for pulmonal sarcoidosis. Four months after the beginning of the therapy she presented with jaundice and a significant increase in serum aminotransferase level. Liver biopsy showed chronic viral B hepatitis of strong activity in the stage of rapidly developed cirrhosis. The patient was treated with lamivudine with slow reduction of prednisolone doses, which resulted in full clinical and biochemical recovery. The second patient was a 40-year-old HBsAg negative female with a previous history of resolved acute B hepatitis who received chemotherapy for non-Hodgkin lymphoma. After the third cycle of chemotherapy a significant increase in aminotransferase level occurred, chemotherapy was discontinued, but aminotransferase level still increased. At that moment she was found to be HBsAg positive, and PCR analysis detected a high viral load. Lamivudine treatment resulted in the patient's recovery and allowed further chemotherapy.
In case of the reactivation of chronic HBV infection during immunosuppressive therapy, it should be stopped and antiviral therapy should be immediately initiated. The use of lamivudine results in rapid suppression of serum HBV DNA, improves the outcome and enables the continuation of immunosuppressive and chemotherapy.
慢性乙型肝炎病毒（HBV）感染的再激活常发生于接受免疫抑制或化疗的乙型肝炎表面抗原（HBsAg）阳性患者，但也可发生于HBsAg阴性、抗-HB核心阳性患者。拉米夫定治疗HBV再激活在大多数患者中产生良好疗效。作者的目的是展示拉米夫定治疗对免疫抑制治疗引起的HBV再激活的效果。
首例患者为一名35岁慢性乙型肝炎病毒感染女性，因肺部结节病接受泼尼松龙治疗。治疗开始4个月后，她出现黄疸，血清转氨酶水平显著升高。肝活检显示在快速进展性肝硬化阶段有严重活动的慢性乙型病毒性肝炎。患者接受拉米夫定治疗，同时缓慢减少泼尼松龙剂量，最终实现完全临床和生化恢复。第二例患者为一名40岁HBsAg阴性女性，既往有急性乙型肝炎康复史，因非霍奇金淋巴瘤接受化疗。在第三个化疗周期后，转氨酶水平显著升高，化疗停止，但转氨酶水平仍持续上升。此时发现她HBsAg阳性，PCR分析检测到高病毒载量。拉米夫定治疗使患者康复，并允许继续化疗。
免疫抑制治疗期间慢性HBV感染再激活时，应停止免疫抑制治疗并立即开始抗病毒治疗。使用拉米夫定可迅速抑制血清HBV DNA，改善治疗结果，并使免疫抑制和化疗得以继续。
