HBV感染的乳腺癌患者化疗后HBV血清学标志物及肝功能变化分析
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摘要
目的探讨乙型肝炎病毒(HBV)感染的乳腺癌患者化疗后HBV血清学标志物及肝功能指标的变化情况及抗病毒感染在预防化疗所致的HBV再激活中的作用。方法收集医院2012年1月-2017年6月接受术后化疗的乳腺癌患者320例,根据化疗前患者是否合并HBV感染分为乙肝表面抗原(HBsAg)阳性组(109例)和阴性组(211例),比较两组患者化疗后肝功能损伤情况以及化疗前后阳性组HBV血清学标志物变化情况,分析预防性使用(44例)和未使用(65例)抗病毒感染治疗对阳性组中患者发生肝功能损伤及HBV再激活的影响。结果阳性组化疗后肝功能损伤发生率高于阴性组(P<0.001);化疗期间阳性组HBsAg滴度、丙氨酸转氨酶(ALT)和谷草转氨酶(AST)水平均显著上升;阳性组中,抗病毒感染治疗患者肝功能损伤率及HBV再激活率均显著低于未使用抗病毒感染治疗患者(P<0.05)。结论合并HBV感染的乳腺癌患者在化疗期间存在HBV再激活可能性,并易发生肝功能损伤,抗病毒感染治疗可预防化疗所致的HBV再激活。
OBJECTIVE To explore the changes of hepatitis B virus(HBV)serological markers and liver function of the breast cancer patients with HBV infections after chemotherapy and observe the effect of antiviral infection on prevention of HBV reactivation induced by chemotherapy.METHODS A total of 320 breast cancer patients who received postoperative chemotherapy from Jan 2012 to Jun 2017 were enrolled in the study and divided into the hepatitis B surface antigen(HBsAg)-positive group with 109 cases and the HBsAg-negative group with 211 cases according to the status of HBV infection before the chemotherapy.The liver function was compared between the two groups of patients after the chemotherapy,the changes of HBV serological markers of the HBsAg-positive group were observed before and after the chemotherapy,and the influence of prophylactic use(44 cases)and non-prophylactic use(65 cases)of antiviral infection therapy on liver function damage and HBV reactivation was analyzed.RESULTS The incidence of liver function damage of the positive group was significantly higher than that of the negative group after the chemotherapy(P <0.001).The HBsAg titer and levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)of the positive group were remarkably elevated during the chemotherapy.In the positive group,the incidence of liver function damage and rate of HBV reactivation were significantly lower in the patients who received the antiviral infection therapy than in the patients who did not receive(P<0.05).CONCLUSION The breast cancer patients complicated with HBV infection may have the possibility of HBV reactivation during the chemotherapy and are more likely to have liver function damage,and the antiviral infection therapy can prevent the HBV reactivation induced by the chemotherapy.
OBJECTIVE To explore the changes of hepatitis B virus(HBV)serological markers and liver function of the breast cancer patients with HBV infections after chemotherapy and observe the effect of antiviral infection on prevention of HBV reactivation induced by chemotherapy.METHODS A total of 320 breast cancer patients who received postoperative chemotherapy from Jan 2012 to Jun 2017 were enrolled in the study and divided into the hepatitis B surface antigen(HBsAg)-positive group with 109 cases and the HBsAg-negative group with 211 cases according to the status of HBV infection before the chemotherapy.The liver function was compared between the two groups of patients after the chemotherapy,the changes of HBV serological markers of the HBsAg-positive group were observed before and after the chemotherapy,and the influence of prophylactic use(44 cases)and non-prophylactic use(65 cases)of antiviral infection therapy on liver function damage and HBV reactivation was analyzed.RESULTS The incidence of liver function damage of the positive group was significantly higher than that of the negative group after the chemotherapy(P <0.001).The HBsAg titer and levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)of the positive group were remarkably elevated during the chemotherapy.In the positive group,the incidence of liver function damage and rate of HBV reactivation were significantly lower in the patients who received the antiviral infection therapy than in the patients who did not receive(P<0.05).CONCLUSION The breast cancer patients complicated with HBV infection may have the possibility of HBV reactivation during the chemotherapy and are more likely to have liver function damage,and the antiviral infection therapy can prevent the HBV reactivation induced by the chemotherapy.
引文
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[3]Shih CA,Chen WC,Yu HC,et al.Risk of severe acute exacerbation of chronic HBV infection cancer patients who underwent chemotherapy and did not receive anti-viral prophylaxis[J].PLoS One,2015,10(8):e0132426.
[4]张崇建,王璐,王丽娜,等.乳腺癌患者化疗后肝功能损伤与乙型肝炎病毒感染的关系分析[J].中华医院感染学杂志,2016,26(4):902-904.
[5]Gonzalez SA,Perrillo RP.Hepatitis B virus reactivation in the setting of cancer chemotherapy and other immunosuppressive drug therapy[J].Clin Infect Dis,2016,62(Suppl 4):S306-313.
[6]中国癌症协会乳腺癌专业委员会.中国癌症协会乳腺癌诊治指南与规范(2011版)[J].中国癌症杂志,2011,21(5):367-417.
[7]Shih CA,Chen WC,Yu HC,et al.Risk of severe acute exacerbation of chronic HBV infection cancer patients who underwent chemotherapy and did not receive anti-viral prophylaxis[J].PLoS One,2015,10(8):e0132426.
[8]Wong WW,Hicks LK,Tu HA,et al.Hepatitis B virus screening before adjuvant chemotherapy in patients with earlystage breastcancer:a cost-effectiveness analysis[J].Breast Cancer Res Treat,2015,151(3):639-652.
[9]Lin PL,Hao Y,Xie J,et al.Real-world effectiveness of everolimus-based therapy versus endocrine monotherapy and chemotherapy in patients of HR+/HER2-breast cancer with liver metastasis in the USA[J].Expert Opin Pharmacother,2015,16(14):2101-2111.
[10]Arai M,Kobayashi J,Saito M,et al.Chemotherapy-induced reactivation of hepatitis B in recurrent breast cancer-a case report][J].Gan To Kagaku Ryoho,2015,42(9):1115-1118.
[11]Paul S,Dickstein A,Saxena A,et al.Role of surface antibody in hepatitis B reactivation in patients with resolved infection and hematologic malignancy:a meta-analysis[J].Hepatology,2017,66(2):379-388.
[12]Remo M,Abraham I,Kankanala V,et al.Hepatitis B reactivation in a patient receiving chemotherapy for breast cancer:a case report[J].Anticancer Res,2017,37(7):3791-3793.
[13]Liu JY,Sheng YJ,Ding XC,et al.The efficacy of lamivudine prophylaxis against hepatitis B reactivation in breast cancer patients undergoing chemotherapy:a meta-analysis[J].J Formos Med Assoc,2015,114(2):164-173.