拉米夫定预防化疗后乙型肝炎再活动致病毒耐药效果

发布时间：2018-05-12 02:30

本文选题：化疗 + 乙型肝炎　；参考：《广东医学》2015年07期

【摘要】：目的探讨肿瘤患者中拉米夫定耐药情况及耐药相关肝炎活动。方法收集住院接受化疗并使用拉米夫定预防性抗病毒治疗的患者72例临床资料。所有患者化疗前及化疗计划完成后定期检测HBV DNA及肝功能情况。患者均按照NCCN指南进行化疗,抗病毒治疗方案为口服拉米夫定0.1 g/d,主要终点为病毒突破及乙型肝炎病毒再活动(病毒突破导致肝炎活动)。分析拉米夫定耐药率及耐药相关肝炎活动。结果入组的72例患者化疗前肝功能均为Child-Pugh A级,HBV DNA阳性46例。拉米夫定使用41.4(5.4~217)周。化疗前HBV DNA定量阳性的患者中,达到病毒完全应答30例(65.2%),出现病毒突破8例(11.1%)。发生乙型肝炎病毒再活动3例,并且1例患者死于肝炎活动所致的急性肝衰竭。另外5例长期随访,未见肝炎活动。结论肿瘤患者中拉米夫定仍有一定的耐药率,需严密监测病毒载量并及时处理病毒耐药。
[Abstract]:Objective to investigate the drug resistance of lamivudine and the activity of resistant hepatitis in tumor patients. Methods 72 patients who received chemotherapy and received lamivudine prophylactic antiviral therapy were collected. HBV DNA and liver function were measured before and after chemotherapy. All patients were treated with chemotherapy according to NCCN guidelines. The antiviral therapy regimen was oral lamivudine 0.1 g / d. The main endpoints were viral breakthrough and hepatitis B virus reactivity (viral breakthrough led to hepatitis activity). To analyze the drug resistance rate of lamivudine and the activity of hepatitis associated with drug resistance. Results the liver function of 72 patients before chemotherapy was Child-Pugh A DNA positive in 46 cases. Lamivudine was used for 41.4 / 5.4 / 217) weeks. In the patients with positive HBV DNA before chemotherapy, 30 cases had complete response to the virus, and 8 cases had the virus breaking through 11. 1%. Hepatitis B virus reactivity occurred in 3 cases, and one patient died of acute liver failure due to hepatitis activity. The other 5 cases were followed up for a long time without hepatitis activity. Conclusion Lamivudine still has a certain drug resistance rate in tumor patients, so it is necessary to monitor the viral load and deal with the drug resistance in time.
【作者单位】：中山大学附属第三医院肿瘤内科;广州医科大学附属第三医院超声科;广州医科大学附属第三医院肾内科;
【基金】：国家自然科学基金面上项目(编号:81372374)
【分类号】：R512.62

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