The Prevention And Therapy Of Hepatitis B Virus (HBV) Reactivation In The Patients With HBV Infection After Treatment With Glucocorticoid By Lamivudine

OBJECTIVE:To analyse retrospectively the efficacy of lamivudine on the prevention and treatment of the hepatitis B virus reactivation in patients with HBV infection after therapy with glucocorticoid.And investigate the the importance and necessity of anti-viral therapy on the prevention and treatment of patients with HBV infection reactivation after glucocorticoid therapy.METHODS:The 126 patients with HBV infection receiving the glucocorticoid treatment in Xiangya hospital during the 2006-2008 were selected and divided into three groups according to the liver function tests and serum HBV-DNA levels.The A group is the patients whose ALT＜80U/L and HBV-DNA＜500copies/ml when they receive the glucocorticoid treatment(the prevention treatment group).The B group is the patients whose ALT＜80U/L and HBV-DNA≧10~4copies/ml when they receive the glucocorticoid treatment(the early treatment group).The C group is the patients whose ALT＞80U/L and HBV-DNA≧10~4 copies/ml after they receive the glucocorticoid treatment(the delayed treatment group).In the prevention and early treatment group,the patients were treated with or without lamivudine therapy.In the delayed treatment group all of the patients were treated by lamivudine.The duration of therapy is dependent on the glucocorticoid treated course,and arranged approximately about 12-18 months.The liver function test and serum HBV-DNA levels were moritored every three to six months.The response rate of therapy and rates of hepatitis B virus reactivation and liver damage were compared among the patients in each group and between the patients with and without lamivudine treatment.RESULTS1.47 patients with chronic HBV infection received glucocorticoid treatment without the use of anti-HBV drug therapy,The rates of hepatitis B virus reactivation up to 61.7%(29/47),liver inflammation recurrence up to 44.68%(21/47) and liver function decompensation rate was 21.28% (10/47) at the finish of the glucocorticoid treatment in a year.2.The rates of hepatitis B virus reactivation(8.3%),inflammation recurrence(8.3%) and the liver function decompensation(8.3%) were significantly lower in the patients treated by lamivudine than that in patients without lamivudine treatment in the Prevention group(74.1%,48.1%,25.9%).3.The rates of hepatitis B virus reactivation(2.5%),inflammation recurrence(2.5%) and the liver function decompensation(2.5%) were significantly lower in the patients treated by lamivudine than that in patients without lamivudine treatment in the early treatment group(45%,40%,15%).4.Among 27 cases in delayed treatment group,9 cases died(case fatality 33.3%),one case occurred gastrointestinal bleeding because of glucocorticoid,the treatment response rate of lamivudine therapy in this group was only about 40.7%.5.The efficacy of lamivudine therapy in this situation was best in the prevation group,and next was in early treatment group.The much higher rates of liver function decompensation occurred and lowest efficacy of lamivudine therapy were got in the delayed treatment group as compared with that in prevation and early treatment groups.CONCLUSION:The immune suppression because of the glucocorticoid can induce reactivation of HBV infection,recurrence of liver inflammation and the liver function decompensation.The lamivudine could efficiently control the HBV reactivation induced by glucocorticoid.The earlier was lamivudine used,the better responses will be in this situation.