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目的探讨乙型肝炎病毒(HBV)表面抗原(HBs Ag)阴性(-)伴核心抗体(Hbc Ab)阳性(+)非霍奇金淋巴瘤患者免疫化疗后肝炎病毒再激活的临床意义。方法选择2005年1月至2012年1月间就诊并接受2个以上疗程免疫化疗的HBs Ag(-)伴HBc Ab(+)非霍奇金淋巴瘤患者105例为研究对象,对其予以含利妥昔单抗的免疫化疗,观察免疫化疗后HBV再激活的发生情况。结果 105例HBs Ag(-)伴HBc Ab(+)非霍奇金淋巴瘤患者中,HBV表面抗体(HBs Ab)(+)者67例,占63.8%。105例患者中,肝功能损害Ⅰ~Ⅲ度者13例,其中1例患者出现了HBV再激活(1.0%),12例证实与HBV再激活引起肝损害无关。1例出现了HBV再激活患者为男性、50岁,病理组织学提示为非霍奇金氏淋巴瘤,弥漫大B细胞性,在4次化疗后10 d发生HBV再激活,经治疗后病情好转。结论 HBs Ag(-)伴HBc Ab(+)淋巴瘤患者免疫化疗后肝炎病毒再激活的临床发生率相对较小,目前对该类患者仍以常规HBV DNA检查、肝功能监测为主,以便更早的发现HBV携带者及感染者。
Objective To investigate the clinical significance of hepatitis virus reactivation after immunochemotherapy in patients with HBsAg negative (-) with core antibody (Hbc Ab) positive (+) non-Hodgkin's lymphoma. Methods A total of 105 HBsAg (-) patients with HBcAb (+) non-Hodgkin's lymphoma treated during January 2005 to January 2012 and receiving two or more courses of chemotherapy were enrolled in this study. Rituximab immunochemotherapy to observe the occurrence of HBV reactivation after immunochemotherapy. Results Among the 105 HBs Ag (-) patients with HBc Ab (+) non-Hodgkin's lymphoma, 67 were HBsAg positive (+), accounting for 63.8%. Of the 105 patients, 13 had grade I or III hepatic impairment, of whom 1 had reactivation of HBV (1.0%), and 12 had no association with HBV reactivation-induced liver damage. One case of reactivation of HBV was male, 50 years old. The histopathologic findings were non-Hodgkin's lymphoma with diffuse large B cell. HBV reactivation occurred 10 days after the 4 chemotherapy cycles and the condition improved after treatment . Conclusions The incidence of hepatitis C reactivation in HBsAg (-) patients with HBcAb (+) lymphoma is relatively low after immunochemotherapy. At present, these patients are still undergoing routine HBV DNA tests and liver function monitoring, Early detection of HBV carriers and infected persons.