Ratner L, Peylan-Ramu N, Wesley R, Poplack D G
Cancer. 1986 Sep 1;58(5):1096-100. doi: 10.1002/1097-0142(19860901)58:5<1096::aid-cncr2820580519>3.0.co;2-b.
Liver function test abnormalities were examined in a retrospective survey in a population of 90 children with acute lymphoblastic leukemia (ALL) treated in a similar fashion with therapy, using primarily methotrexate, mercaptopurine, vincristine, and prednisone. A twofold or greater elevation of serum glutamyl pyruvic transaminase (SGPT) was found in 80% of the patients during induction therapy, in 63% of the patients during maintenance therapy, and 31% of the patients who completed therapy. Circulating hepatitis B virus surface antigen (HBsAg) was noted in 26% of patients with liver function test abnormalities during maintenance therapy, and 45% of patients with liver function test abnormalities after the completion of therapy. Hepatitis B virus infection was therefore, the most important single cause of abnormal liver function during remission in our patient population. Though others have asserted that hepatitis B virus infection is relatively benign in immunosuppressed individuals, in our population, this agent often caused severe pathological and clinical sequelae. This may be related to the high frequency (50%) of co-infection with the delta agent in our HBsAg-positive patients. Furthermore, hepatitis B virus surface antigenemia conferred an adverse prognostic influence for these children in terms of their leukemia-free survival.
在一项回顾性调查中，对90名急性淋巴细胞白血病（ALL）儿童进行了肝功能检查异常情况的研究。这些儿童接受了以甲氨蝶呤、巯嘌呤、长春新碱和泼尼松为主的相似治疗方案。在诱导治疗期间，80%的患者血清谷丙转氨酶（SGPT）升高两倍或更多；在维持治疗期间，63%的患者出现该情况；在完成治疗的患者中，这一比例为31%。在维持治疗期间，26%肝功能检查异常的患者检测出循环乙肝病毒表面抗原（HBsAg）；在完成治疗后，45%肝功能检查异常的患者检测出该抗原。因此，乙肝病毒感染是我们患者群体缓解期肝功能异常的最重要单一原因。尽管其他人声称乙肝病毒感染在免疫抑制个体中相对良性，但在我们的患者群体中，这种病原体常导致严重的病理和临床后遗症。这可能与我们HBsAg阳性患者中丁型肝炎病毒共感染的高频率（50%）有关。此外，乙肝病毒表面抗原血症对这些儿童的无白血病生存具有不良预后影响。
