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目的:探讨化疗引起的乳腺癌患者肝功能损害与乙肝病毒(HBV)感染的相关性及抗病毒治疗在预防化疗引起的HBV再激活中的作用。方法:2006年3月-2010年10月在武汉市第三医院接受化疗的病理确诊为乳腺癌患者(包括术后辅助化疗)为研究对象,比较HBs Ag阴性138例和HBs Ag阳性50例患者化疗后肝功能损害的发生情况,并分析在HBs Ag阳性患者中,预防性使用(21例)与未预防性使用(27例)抗病毒药物拉米夫定后乙肝病毒再激活率的差异。结果:化疗后出现肝功能损害的乳腺癌患者中,HBs Ag阳性患者(31.25%)与HBs Ag阴性患者(16.67%)所占比例的差异有统计学意义(P<0.001)。化疗前预防性使用拉米夫定(4.62%)与未预防性使用(25.93%)拉米夫定,患者出现HBV再激活率的差异亦有统计学意义(P<0.01)。结论:乳腺癌患者化疗后,HBs Ag阳性患者较HBs Ag阴性患者更易出现肝功能损害,预防性使用核苷类似物抗病毒药物拉米夫定,可明显降低乳腺癌合并乙肝患者化疗后HBV再激活肝炎的发生。
OBJECTIVE: To investigate the correlation between hepatitis B virus (HBV) infection and liver damage induced by chemotherapy in patients with breast cancer and the role of antiviral therapy in preventing HBV reactivation induced by chemotherapy. Methods: From March 2006 to October 2010, 138 patients with breast cancer (including postoperative adjuvant chemotherapy) were enrolled in the Third Affiliated Hospital of Wuhan City. The pathological findings of 138 patients with HBsAg-negative and 50 patients with HBsAg-positive The incidence of hepatic dysfunction after chemotherapy was analyzed and the difference in HBV reactivation rate after lamivudine prophylaxis (21 cases) versus non-prophylactic (27 cases) antiviral HBsAg-positive patients was analyzed. Results: There was a statistically significant difference in the proportion of HBsAg-positive patients (31.6%) and HBsAg-negative patients (16.67%) among patients with liver cancer who had liver dysfunction after chemotherapy (P <0.001). There was also a statistically significant difference in HBV reactivation rate between patients receiving lamivudine and prophylactic lamivudine before chemotherapy (4.62% vs. 25.93%, P <0.01). Conclusion: After chemotherapy for breast cancer patients, HBsAg-positive patients are more likely to have liver damage than HBsAg-negative patients. Preventive use of nucleoside analogue antiviral lamivudine can significantly reduce the incidence of HBV reactivation in patients with breast cancer and hepatitis B after chemotherapy Activate the occurrence of hepatitis.