乳腺癌化疗相关HBV再激活的研究进展

发布时间：2018-03-20 15:22

本文选题：乙型肝炎病毒　切入点：再激活　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：乳腺癌患者接受细胞毒化疗可以导致机体处于潜伏或者静止状态的乙型肝炎病毒(hepatitis B virus,HBV)再激活,甚至出现肝组织损伤,临床可表现为无症状自限性肝炎,或暴发性肝衰竭所致的化疗中断甚至死亡。研究表明,在乙型肝炎表面抗原(hepatitis B surface antigen,HBs Ag)、乙型肝炎核心抗体(hepatitis B core antibody,HBcAb)阳性乳腺癌化疗相关HBV再激活的患者中,HBV再激活率达14.7%~55.6%,HBV再激活所致的肝炎发生率达16%~58.8%,HBV再激活所致的化疗中断率则达12.7%~71%。HBV再激活的发病机理目前尚未完全阐释明确,通常认为是化疗药物导致HBV与机体之间的免疫失衡;此外,也与化疗药物对HBV的直接激活有关,其危险因素涉及HBV病原学状态、HBV DNA载量、HBV共价闭合环状DNA(covalently closed circular DNA,cccDNA)载量、HBV基因突变、HBsAg氨基酸置换以及化疗方案、年龄等方面。为了减少乳腺癌化疗相关HBV再激活及其相关并发症的发生,化疗前应常规筛查HBV感染(HBsAg、HBcAb),对HBs Ag阳性患者建议预防性给予抗病毒药物(核苷(酸)类似物);对HBs Ag阴性、HBcAb阳性患者则建议密切随访,及早发现HBV再激活并启动抗病毒治疗。
[Abstract]:Chemotherapy with cytotoxic chemotherapy in breast cancer patients can lead to the reactivation of hepatitis B virus hepatitis B virus (HBV) in latent or stationary state, and even liver tissue damage, which can be characterized by asymptomatic self-limited hepatitis. Or chemotherapy interruptions or even deaths due to fulminant liver failure. In patients with hepatitis B surface antigen-HBs Agna, hepatitis B core antibody HBcAb-positive breast cancer patients with chemotherapy-associated reactivation of HBV, the rate of HBV reactivation was 14.7% and 55.6% respectively. The incidence of hepatitis caused by HBV reactivation was 1658.8%. At present, the pathogenesis of HBV reactivation has not been fully explained. It is generally believed that chemotherapeutic drugs cause immune imbalance between HBV and the body; in addition, it is also related to the direct activation of HBV by chemotherapeutic drugs. The risk factors are associated with HBV DNA load and HBV covalently closed cyclic DNA(covalently closed circular DNA (HBV-DNA) load, the amino acid replacement of HBV-gene mutation and the chemotherapy regimen. In order to reduce the incidence of chemotherapy-related HBV reactivation and related complications in breast cancer, Before chemotherapy, routine screening should be made for HBcAban of HBV infected HBs, and prophylactic administration of antiviral drugs (nucleoside (acid) analogue) should be given to HBsAg positive patients, while for HBsAg negative HBcAb positive patients, close follow-up should be suggested to detect HBV reactivation and initiate antiviral therapy as early as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62;R737.9

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