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目的:探讨乙肝表面抗原(HBsAg)(-)核心抗体(HBcAb)(+)肿瘤患者化疗后引起乙型肝炎病毒(HBV)再激活的治疗与监控。方法:报道3例HBsAg(-)HBcAb(+)的肿瘤患者化疗过程中出现HBV再激活的病例,针对可行的治疗监控措施进行文献复习。结果:1例最初乙肝表面抗体(HBsAb)(+)、HBcAb(+)的非霍奇金淋巴瘤(NHL)患者经过多次化疗后转变为HBsAg(+)、e抗原(HBeAg)(+)、HBcAb(+);1例乙肝e抗体(HBeAb)(+)、HBcAb(+)的霍奇金淋巴瘤(HL)患者化疗后乙肝模式未改变,乙肝病毒载量(HBV-DNA)定量结果增高;1例HBsAb(+)、HBeAb(+)、HBcAb(+)的肝癌患者行肝动脉化疗栓塞术(TACE)后出现HBV-DNA定量结果增高。3例HBsAg(-)患者化疗后均出现HBV再激活,经抗病毒治疗后获得良好转归。结论:不仅对于HBsAg(+)的患者,对于即使处于康复期的既往有急性或慢性乙肝病史的HBsAg(-)、HBcAb(+)患者,在应用化疗或免疫抑制剂治疗时均需严密监测血清HBsAg、肝功能及HBV-DNA定量的动态变化,必要时实施预防性抗病毒治疗,以免中止原有治疗计划延误病情。
Objective: To investigate the treatment and monitoring of hepatitis B virus (HBV) reactivation after chemotherapy in patients with HBsAg (-) core antibody (HBcAb) (+). Methods: Three patients with HBsAg (-) HBcAb (+) were reported to have HBV reactivation during the course of chemotherapy. Literature review was given on feasible treatment monitoring measures. Results: One patient with non-Hodgkin’s lymphoma (NHL) who initially had HBsAb (+) and HBcAb (+) was converted to HBsAg (+), e antigen (HBeAg) (HBeAb) (+) and HBcAb (+) in patients with Hodgkin’s lymphoma (HL) were not changed after chemotherapy, and the results of quantitative analysis of HBV-DNA (TACE) in one case of HCC patients with HBsAb (+), HBeAb (+), and HBcAb (+) increased. All 3 HBsAg (-) patients showed reactivation of HBV after chemotherapy, and got a good prognosis after antiviral treatment. Conclusions: Serum levels of HBsAg (-) and HBcAb (+) in patients with HBsAg (+) and prior HBsAg (-) and HBsAg-positive patients with prior history of acute or chronic hepatitis B should be carefully monitored in both chemotherapy and immunosuppressive therapy HBsAg, liver function and HBV-DNA quantitative dynamic changes, if necessary, the implementation of preventive antiviral therapy, so as not to suspend the original treatment plan to delay the disease.