蒋凤莲　施为建　栾　峰　鞠文东　周巧云　李全泳　王　丽　宋浩杰广东省中山市博爱医院肿瘤内科，广东中山　528400

HBsAg（-）伴HBcAb（+）妇科肿瘤患者TP化疗方案化疗后乙肝病毒再激活的临床研究

蒋凤莲施为建栾峰鞠文东周巧云李全泳王丽宋浩杰
广东省中山市博爱医院肿瘤内科，广东中山528400

目的 探讨HBsAg（-）伴HBcAb（+）妇科肿瘤患者行TP方案化疗后发生乙肝病毒再激活的肝功能损害情况。 方法 收集我院近7年收治的60例使用TP方案化疗的妇科肿瘤患者的临床资料，根据HBcAb结果不同分为实验组及对照组，分析其肝脏损害程度及乙肝病毒再激活情况。结果 实验组肝功能损害60.0%（18/30），对照组肝功能损害43.3%（13/30），两组差异无统计学意义（P>0.05）；实验组肝功能损害Ⅰ度+Ⅱ度12例，Ⅲ度+Ⅳ度6例，对照组Ⅰ度+Ⅱ度12例，Ⅲ度+Ⅳ度1例，实验组肝功能损害程度更严重，两组差异有统计学意义（P<0.05）。实验组4例胆红素升高，对照组2例胆红素升高，两组差异无统计学意义（P>0.05）；实验组乙肝再激活 1× 103Copies/mL1×105Copies/mL 2例，对照组乙肝再激活0例，两组差异具有统计学意义（P<0.05）。实验组22例（73.3%）继续按期化疗，6例（20%）延期化疗，2例（6.7%）终止化疗；对照组30例按期化疗，两组差异有统计学意义（P<0.05）。结论 HBsAg（-）伴HBcAb（+）妇科肿瘤患者TP化疗严密观察肝功能，检测乙肝HBsDNA定量检测。

妇科肿瘤；乙型肝炎病毒；再激活；化疗

[Abstract]Objective To discuss the liver function impairment by HBV reactivation after TP chemotherapy in patients with gynecologic tumors with HBsAg（-）and HBcAb（+）.Methods Clinical materials of 60 patients with gynecologic tumors after TP chemotherapy were collected and divided based on HBcAb results into study group and control group to analyze the liver function impairment and HBV reactivation.Results The rate of liver function impairment was 60.0% （18/30）in the study group and 43.3%（13/30）in the control group，which was not significantly different（P>0.05）. There were 12 cases withⅠandⅡdegree liver function impairment，and 6 cases withⅢandⅣdegree in the study group；while in the control group，there were 12 cases withⅠandⅡdegree and 1 case withⅢandⅣ degree.The degree of liver function impairment was significantly severe in the study group than in the control group（P<0.05）.Enhanced bilirubin was observed in 4 cases of study group and 2 cases of control group，which was not significantly different（P>0.05）.As to HBV reactivation，5 cases were 1×103Copies/mL 105；while there was 0 case of HBV reactivation in control group，which was significantly different between two groups （P<0.05）.22 cases（73.3%）were given continuous regular chemotherapy，6 cases（20.0%）were given delayed chemotherapy，and 2 cases（6.7%）withdrew from chemotherapy；while 30 cases in control group were given regular chemotherapy，which was significantly different（P<0.05）.Conclusion In patients with gynecologic tumors with HBsAg（-）and HBcAb（+），liver function should be closely monitored during TP chemotherapy and HBsDNA should be detected.

[Key words]Gynecologic tumor;Hepatitis B virus;Reactivation;Chemotherapy

化疗是妇科恶性肿瘤重要的治疗方法，可以杀灭隐匿的肿瘤细胞，防止转移和复发；对于复发性和难治性妇科恶性肿瘤，化疗也是极为重要的选择。近年来已将紫杉醇加顺铂类（TP）方案作为进展期妇科肿瘤一线标准化疗治疗方案。我国是乙肝大国，3岁以上乙型病毒表面抗原阳性人数约占总人口的9.9%[1]，携带乙肝病毒的肿瘤患者化疗后肝功能损害及乙肝病毒再激活明显升高，已有指南明确规定HBsAg（+）的患者化疗同时需进行抗乙肝病毒治疗，HBsAg（-）HBcAb（+）是既往感染乙肝的标志，化疗期间是否应预防性进行抗病毒治疗仍存在争议。本研……