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乳腺癌患者接受细胞毒化疗可导致机体潜伏或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,HBsAg)、乙型肝炎核心抗体(hepatitis B core antibody,HBcAb)阳性乳腺癌相关HBV再激活的患者中,HBV再激活相关肝炎发生率达18.4%~23.5%,相关化疗中断率则达12.7%~33.6%。HBV再激活的发病机制一方面是化疗药物导致的HBV与机体之间的免疫失衡,另一方面则是化疗药物对HBV的直接激活,其危险因素与HBV病原学状态、HBV DNA载量以及化疗方案等有关。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,对HBsAg阳性患者应预防性使用抗病毒药物,并对HBsAg阴性、HBcAb阳性患者则应密切随访,及早发现HBV再激活并启动抗病毒治疗。
Cytotoxic chemotherapy in breast cancer patients leads to the reactivation of the latent or quiescent state of the body’s hepatitis B virus (HBV), and even liver damage, which can be clinically manifested as asymptomatic self-limiting hepatitis or fulminant liver Chemotherapy failure caused by failure or even death. Studies have shown that the incidence of hepatitis associated with HBV reactivation in patients with hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (HBcAb) -positive breast cancer associated with reactivation of HBV is up to 18.4% ~ 23.5%, the relevant chemotherapy interruption rate reached 12.7% ~ 33.6%. On the one hand, the pathogenesis of HBV reactivation is the immune imbalance between HBV and the body caused by chemotherapeutic drugs. On the other hand, the direct activation of HBV by chemotherapeutic drugs, the risk factors associated with HBV etiology, HBV DNA load and chemotherapy Programs and so on. In order to reduce the incidence of chemotherapy-related HBV reactivation and its associated complications in breast cancer, HBV infection should be routinely screened before chemotherapy, prophylactic use of antiviral drugs should be given to HBsAg-positive patients, and HBsAg-negative and HBcAb-positive patients should be closely followed , Early detection of HBV reactivation and start antiviral therapy.