Li Hong, Zhang Hong-Min, Chen Li-Fen, Chen Ya-Qin, Chen Ling, Ren Hong, Hu Huai-Dong
Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, 76, Linjiang Road, 400010 Chongqing, China.
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Clin Res Hepatol Gastroenterol. 2015 Feb;39(1):80-92. doi: 10.1016/j.clinre.2014.07.010. Epub 2014 Sep 4.
Hepatitis B viral (HBV) reactivation in lymphoma patients undergoing chemotherapy is associated with significant morbidity and mortality. Increasingly, lamivudine is being used to prevent hepatitis B reactivation. To assess the effects of prophylactic lamivudine on reactivation and mortality following chemotherapy in lymphoma patients who are hepatitis B surface antigen (HBsAg)-positive, we searched Medline/PubMed, Ovid MEDLINE, EMBASE, Web of Knowledge and the Cochrane Library for studies through November 2013. Statistical analysis was performed using REVMAN. Fourteen studies consisting of 636 patients were included in the analysis. The rate of HBV reactivation, incidence of hepatitis and incidence of hepatitis due to HBV reactivation in patients with lamivudine prophylaxis was significantly lower than those with no prophylaxis. Risk ratios [RRs] were 0.25 (95% confidence intervals [CI] 0.13-0.51; P=0.0001), 0.40 (95% CI 0.26-0.63; P<0.0001), and 0.21 (95% CI 0.09-0.51; P=0.0005) respectively. In addition, patients given prophylactic lamivudine had significant reductions in overall mortality and mortality attributable to HBV reactivation compared with control group. Risk ratios [RRs] were 0.45 (95% CI 0.29-0.70; P=0.0004) and 0.41 (95% CI 0.20-0.84; P=0.01) respectively. Chemotherapy disruption was not significantly different between the two groups. Risk ratios [RRs] were 0.34 (95% CI 0.09-1.26; P=0.11). Prophylactic therapy with lamivudine for HBsAg-positive lymphoma patients who are undergoing chemotherapy may reduce the risk for HBV reactivation, hepatitis due to HBV reactivation, overall mortality and mortality attributable to HBV reactivation. Additionally, patients with preventive lamivudine had a trend towards the decreased incidence of chemotherapy disruption.
接受化疗的淋巴瘤患者中，乙肝病毒（HBV）再激活与显著的发病率和死亡率相关。越来越多地，拉米夫定被用于预防乙肝再激活。为了评估预防性使用拉米夫定对乙肝表面抗原（HBsAg）阳性的淋巴瘤患者化疗后再激活和死亡率的影响，我们检索了截至2013年11月的Medline/PubMed、Ovid MEDLINE、EMBASE、Web of Knowledge和Cochrane图书馆中的研究。使用REVMAN进行统计分析。分析纳入了14项研究，共636例患者。接受拉米夫定预防的患者中HBV再激活率、肝炎发病率以及HBV再激活导致的肝炎发病率显著低于未接受预防的患者。风险比[RRs]分别为0.25（95%置信区间[CI] 0.13 - 0.51；P = 0.0001）、0.40（95% CI 0.26 - 0.63；P < 0.0001）和0.21（95% CI 0.09 - 0.51；P = 0.0005）。此外，与对照组相比，接受预防性拉米夫定治疗的患者总体死亡率以及HBV再激活导致的死亡率显著降低。风险比[RRs]分别为0.45（95% CI 0.29 - 0.70；P = 0.0004）和0.41（95% CI 0.20 - 0.84；P = 0.01）。两组之间化疗中断情况无显著差异。风险比[RRs]为0.34（95% CI 0.09 - 1.26；P = 0.11）。对于接受化疗的HBsAg阳性淋巴瘤患者，预防性使用拉米夫定可能会降低HBV再激活、HBV再激活导致的肝炎、总体死亡率以及HBV再激活导致的死亡率的风险。此外，接受预防性拉米夫定治疗的患者化疗中断发生率有下降趋势。
