The Clinical Study Of Lymphoma Combined With HBV Infection

Background and Purpose:It's have confirmed that the pathogenesis of lymphoma is related to EBV and HCV. But recent studies found that HBV is also have some relevance.For the high prevalence of HBV infection area,HBV not only addicted to the characteristics of liver cells,but lymphocytes.Lymphoma has 3%~4% of the cancer of the world,and 4% annual rate of increase, the patients who with lymphoma with HBV infection are groups that cann't be neglected .And the relationship between them both have extensive attention in recent years.To explore the clinical features and correlation of the lymphoma patients with HBV infection ,as well as the influence of HBV infection for lymphoma treatment and prognosis,this paper retrospectively analyzed the clinical features of lymphoma patients,the change of liver function after chemotherapy and related factors of liver damage between 186cases with HBV infection in lympnoma patients and 579 patients without HBV infection .Methods:We studied a cohort of 765 patients with lymphoma, diagnosed between January 2003 and December 2010 at the Jilin University hospital. All of the patients received formal chemotherapy. We used SPSS 13.0 statistical software package to sort and analyze the data of 765 cases of patients with lymphoma and selected characteristic clinical indicators (age at onset, menstrual status, tumor size,, clinical stage, group,IPI score , chemotherapy plan, degree of liver damage ,etc.).Then according to SPSS13.0 package and processing requirements, we quantified these and usedχ~2 to test the count data of clinical indicators. We used Fisher exact test to analyze the related factors of liver injure after chemotherapy,multiple logistic regression model of binary is used to multivariate analysis the risk factors of liver injure, taking P <0.05 as statistical significant and P <0.01 as conspicuous significant statistical.Results:This study included 765 cases of lymphoma patients, with HBV infection in 186 cases, accounting for 24.3%. Compared with lymphoma patients not infected with HBV, HBV infection patients have their own clinical features of lymphoma. Lymphoma patients with HBV infection occurs in men (61.8% vs 53.5%, P <0.05), the median onset age of onset was 45.7±18.7 years, followed by middle age, old age minimum. More common occurs in B-cell lymhoma (76.9% and 23.7%, P <0.05) is, stageⅢandⅣpatients (67.7% and 48.9%, P <0.05), and more occurred in the low-threatening low - medium risk group (59.7%, 111/186).Compared with lymphoma patients not infected with HBV,HBV infection patents are more vulnerable to liver injury (67.2% and 29.4%, P <0.05), mainly in gradeⅠ,Ⅱdegree , especially in degreeⅡ.Compared with each other between the two liver injury groups,Ⅰ+Ⅱdegree and degree of gradeⅢ+Ⅳdegrees,ⅠandⅡdegree level,Ⅲdegree,Ⅳdegrees P <0.05, statistically significant. Liver damage occurs mainly in stageⅢ,Ⅳstage patients (71.2% and 28.8%, P <0.05), mainly to young, no significant gender differences. No significant difference in the number of chemotherapy courses between liver injury patients and without liver injury patients. But the patients who with application of chemotherapy in glucocorticoid and epirubicin have a higher incidence of liver injury than that without application of the two chemotherapy drugs. The liver injurey rate in not application of antiviral drugs during chemotherapy in patients was significantly higher than those applied antiviral drugs (79.9% and 34.6%), P values between <0.05, significantly different. Liver injury after chemotherapy Risk factors for multivariate analysis showed that age, gender, disease stage, histological type, anti-virus treatment and liver function have no significant correlation between the damage occurred, and the application of doxorubicin and glucocorticoid are associated with liver damage after chemotherapy (P <0.05). It's showed that with the application of binary logistic regression model and multiple back by Wald for the gradual elimination of the factor screening, only glucocorticoids associated with HBV infection in lymphoma liver damage after chemotherapy in patients with high risk factors (P = 0.024, OR = 11.245).With HBV infection after chemotherapy in lymphoma patients prone to HBV reactivation, reactivation rate was 12.4% (23/186), and HBsAg-positive HBV reactivation was significantly higher than HBsAg negative patients (28.4% and 1.8% P <0.05) after chemotherapy. Received rituximab with chemotherapy regimens of chemotherapy in lymphoma patients with HBV infection, there are 12 cases of HBV reactivation, the activation rate was 21.8% (12/55). In 55 patients, without prophylactic antiviral treatment is 38 cases, 11 patients had HBV reactivation, the activation rate was 28.9%, and 2 patients dead because of HBV reactivation causes fulminant hepatitis; prophylactic antiviral Treatment of 17 cases, only 1 case of HBV reactivation, the activation rate was 5.9%, compared between them, P <0.05, significantly different.It can be seen that prophylactic antiviral therapy , be used with caution or not glucocorticoid drugs can significantly reduce the lymphoma patients with HBV infection in HBV reactivation after chemotherapy.Conclusion:1. Lymphoma patients with HBV infection occurs in men, to B-cell lymphoma more common..2. Lymphoma patients with HBV infection after chemotherapy are more vulnerable to liver injury to gradeⅠ,Ⅱdegree of liver injury based, and could easily lead to HBV reactivation.3. Lymphoma patients with HBV infection after chemotherapy induced liver damage occurred in stageⅢ,Ⅳof patients, glucocorticoids are independent factors of liver injury after chemotherapy.4. Virological factors and chemotherapy drugs both can be infected with HBV reactivation of HBV in patients with lymphoma, prophylactic antiviral therapy, caution or without glucocorticoid drugs can significantly reduce the incidence of reactivation.