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目的探讨在抗病毒治疗的前提下应用利妥昔单抗(商品名:美罗华)联合化疗对乙肝表面抗原阳性(HBsAg+)淋巴瘤患者肝功能的影响。方法回顾性分析2001年7月至2011年6月病理确诊B细胞非霍奇金淋巴瘤伴HBsAg阳性的39例住院患者的临床资料。其中男31例,女8例,中位年龄47(21-83)岁。所有患者均接受利妥昔单抗联合化疗。早期有7例患者未进行抗病毒治疗,另32例患者每日口服拉米夫定100mg或恩替卡韦500μg,化疗后定期监测HBV-DNA。结果应用利妥昔单抗联合化疗治疗B细胞淋巴瘤107例。其中HBsAg阳性者39例,占36.4%。病毒高拷贝数8例(HBV DNA>104copy.mL-1),未抗病毒治疗的病人肝功能损害发生率为57.1%,有4例出现急性暴发性肝衰竭,3例死亡(死亡率高达42.9%),抗乙肝病毒治疗的有32例,有12例出现肝功能损害,发生率为37.5%,明显低于未抗病毒治疗者,抗病毒治疗的32例中包括乙肝大三阳6例及病毒高拷贝数8例(4例乙肝大三阳),乙肝大三阳中有4例发生肝功能损害,病毒高拷贝数患者中有4例出现肝功异常,大多为Ⅰ~Ⅱ度肝功能损害。结论在有效抗病毒及激素减量使用的同时,密切监测乙肝DNA,并严格遵循抗病毒药物的停药时间,HBsAg阳性淋巴瘤患者接受利妥昔单抗联合化疗是安全的。
Objective To investigate the effect of rituximab (Rituximab) combined with chemotherapy on liver function in patients with hepatitis B surface antigen (HBsAg +) lymphoma under antiviral therapy. Methods The clinical data of 39 hospitalized patients with pathologically confirmed B-cell non-Hodgkin’s lymphoma and HBsAg positive from July 2001 to June 2011 were retrospectively analyzed. There were 31 males and 8 females, with a median age of 47 (21-83) years. All patients received rituximab in combination with chemotherapy. In the early 7 patients were not treated with antiviral therapy, the other 32 patients daily oral lamivudine 100mg or entecavir 500μg, regular monitoring of HBV-DNA after chemotherapy. Results Rituximab combined with chemotherapy in the treatment of 107 cases of B cell lymphoma. Among them, 39 cases were HBsAg positive, accounting for 36.4%. Eight patients (HBV DNA> 104 copy.mL-1) had a high copy number of virus. The incidence of liver damage was 57.1% in patients without antiviral therapy, 4 patients developed acute fulminant hepatic failure, and 3 patients died (mortality rate was 42.9 %), Anti-hepatitis B virus treatment in 32 cases, 12 cases of liver damage, the incidence was 37.5%, significantly lower than those without anti-virus treatment, 32 cases of antiviral therapy including HBeAg in 6 cases and High copy number of virus in 8 cases (4 cases of hepatitis B and Sanyang), hepatitis B and Sanyang in 4 cases of liver damage, high copy number of patients in 4 cases of liver abnormalities, mostly grade Ⅰ ~ Ⅱ liver dysfunction . CONCLUSIONS: In the meanwhile, effective use of anti-virus and steroid is under close monitoring of hepatitis B DNA and strictly follow the withdrawal time of antiviral drugs. It is safe for patients with HBsAg positive lymphoma to receive rituximab combined with chemotherapy.