摘要
目的分析既往感染乙型肝炎病毒（HBV）的HBsAg（-）HBcAb（＋）弥漫大B细胞淋巴瘤（DLBCL）患者在接受CHOP和R—CHOP方案化疗后的肝功能耐受情况。方法2005年1月至2008年12月收治的86例HBsAg（-）HBcAb（＋）DLBCL患者，其中CHOP方案组47例，R．CHOP方案组39例，均未给予抗乙肝病毒治疗，比较两组患者各周期化疗后及化疗结束后1年内肝功能损害程度。结果CHOP方案组和R-CHOP方案组在第5个周期化疗后，肝功能损害发生率分别为28．6％和6．2％，差异有统计学意义（P=0．026）；而在第1、2、3、4、6个周期化疗后，肝功能损害发生率差异均无统计学意义（均P〉0．05）。CHOP方案组和R—CHOP方案组的大部分患者中在不同化疗周期时肝功能正常，均未见Ⅳ度肝功能损害。CHOP方案组和R-CHOP方案组患者在化疗结束后1～3个月肝功能正常者分别占60．0％和68．0％，4～6个月占92．3％和75．0％，7～9个月占90．0％和81．8％，10～12个月占92．3％和92．9％，差异均无统计学意义（均P〉0．05）。结论HBsAg（-）HbcAb（＋）的DLBCL患者接受CHOP方案或R—CHOP方案化疗时，肝功能损害发生率均很低，且利妥昔单抗的应用也并未增加患者肝功能损害的发生率，因此本研究不支持常规预防性抗乙肝病毒治疗，但治疗期间应密切监测患者的肝功能、乙肝标志物及HBV—DNA水平。
Objective To analyze the liver function in patients with diffuse large B-cell lymphoma （DLBCL）, who are hepatitis B surface antigen negative/antibody to hepatitis B core antigen positive （ HBsAg -/HBeAb ＋ ）, treated with CHOP and R-CHOP regimens. Methods In this retrospective study, 86 DLBCL patients, who were HBsAg -/HBcAb ＋ , were collected from Cancer Hospital of Chinese Academy of Medical Sciences between January 2005 and December 2008. The patients were given at least two cycles of chemotherapy using CHOP-like or R-CHOP-like regimen without anti-HBV treatment, and followed-up for at least 12 months after completion of therapy. Results Forty-seven patients received CHOP-like regimen while 39 patients received R-CHOP-like regimen. There were no significant differences in the degree of liver dysfunction between CHOP group and R-CHOP group after the 1st, 2nd, 3rd,4th and 6th cycles（22.7% -46.7% with CHOP and 17.6% -34.2% with R-CHOP, respectively, （ all P 〉 0.05 ）, except for the 5th cycles（28.6% vs. 6.2% ,P =0. 026）. Liver function in most patients in CHOP group and R-CHOP group was normal after every cycle （53. 3%-77. 3% and 65. 8%-93. 8%, respectively ）. Meanwhile, there were no significant differences in the degree of liver dysfunction between CHOP group and R-CHOP group in the lst-3rd month, 4th-6th month,7th-9th month and 10th-12th month after completion of therapy（7.7%-d0. 0% with CHOP and 7.4%-32. 0% with R-CHOP, respectively, all P 〉 0. 05）. Conclusions The present study reveals a low incidence of liver dysfunction in HBsAg -/HBcAb ＋ DLBCL patients, both in CHOP group and in R-CHOP group. It may indicate a potential low incidence of HBV reactivation in these groups, and Rituximab do not increase the rate of liver dysfunction. Therefore, these data may not support regularly prophylactic antiviral therapy during chemotherapy, but close monitoring of liver function, HBV serum markers and HBV DNA level are demanded.
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2012年第5期385-389,共5页
Chinese Journal of Oncology
基金
国家自然科学基金（30873012）
人事部回国人员科技活动项目择优资助课题
高等学校博士学科点专项科研基金资助课题（200800230019）
吴阶平基金资助项目（320.6750.09189）
