The Effect Of Pre-emptive Treatment With Nucleoside Analogues Against Hepatitis B Virus(HBV) Reactivation In Patients With Malignancies After Chemotherapy

Objective:To study the hepatitis B virus reactivation in patients with malignanciesafter chemotherapy, and discuss the therapeutic efficacy of pre-emptive treatment withnucleoside analogues against hepatitis B virus reactivation.Methods:741patients with malignancies undergoing chemotherapy were screenedin the medical oncology and hematology inpatient department of the second affiliatedhospital of Da Lian Medical University from March1,2011to March1,2013. Therewere63patients with HBV infected. According to the purpose of the study,40patientswere enrolled. There were18patients (8males and10females) in the observation groupand22patients (17males and5females) in the control group. The patients receivednucleoside analogues such as lamivudine100mg/d or entecavir0.5mg/d from at leastone week to before chemotherapy six months after the course of treatment, served as theobserved group. The patients did not receive nucleoside medicines for antiviral therapybefore chemotherapy, who received only the liver protected and enzyme reducedtheraphy, such as glycyrrhizic acid, glutathione and jiangmeiling capsules when thelevel of ALT rised, served as the control grouop. At the same time, virology index wasdetected, they took nucleoside analogues as antiviral therapy once HBV DNAreactivation appeared, up to six months after the course of chemotherapy. After adetailed review of clinical history, information on the incidence of HBV reactivation,quantify of the five hepatitis B indexes, biochemical indicators (ALT, ALB, TBil),virology indicators (HBV DNA), and clinical manifestations of the40patients wereobtained and analysed in two groups.Results:1.The differences of age, ALT, AST, TBil, ALB, PTA, BMI, the level of HBV DNAand complications were not statistically significant before chemotherapy between theobserved and control grouops (P>0.05). However, male patients in the control group was significantly more than that those in the observation group (P<0.05).2.At4and12weeks after chemotherapy, the end of chemotherapy, and followed for24weeks, the incidence of HBV reactivation after chemotherapy in the control andobserved group were0.00%、5.56%、11.11%、11.11%and13.64%、27.27%、40.90%、59.09%. The incidences were on the rise as chemotherapy cycles extended, and thedifferences were statistically significant(P=0.002).3.4weeks after chemotherapy, the differences of ALT, AST, TBil, ALB, HBsAg,HBsAb, HBeAg, HBeAb, HBcAb and HBV DNA between the two groups were notstatistically significant (P>0.05). However, PTA in the control group was lower than inthe observed group.12weeks after chemotherapy, the levels of ALT, AST, quantifies ofHBsAg and HBV DNA in the control group were higher than in the observed group, thedifferences between the two groups were statistically significant(P<0.05). At the end ofchemotherapy, the differences of ALT and AST were statistically significant (P<0.05).There were9out of18patients in the observed group and14out of22patients in thecontrol group followed for24weeks.The differences of ALT, AST, TBil, ALB, PTA,quantify of the five hepatitis B index and HBV DNA between the two groups were notstatistically significant (P>0.05).4.In this study, the main clinical manifestations after chemotherapy weregastrointestinal reactions, the right epigastric discomfort, jaundice and so on. Themanifestation of gastrointestinal reactions were loss of appetite and nauseawithoutvomit.Compared with the control group, the incidence of the loss of appetite (38.89%vs63.63%) and nausea (44.44%vs68.18%) were lower in the observed group.Thedifference were significant(P<0.05). The incidence of right epigastric discomfort andjaundice between the two groups were not statistically different (P>0.05).Conclusions:Hepatitis B virus reactivation could be induced by chemotherapy inpatients with malignancies, and the incidence was on the rise as chemotherapy cyclesextended, so it is essential to monitor liver function and HBV DNA in process ofchemotherapy. Compared with take antiviral therapy after hepatitis B virus reactivation,pre-emptive treatment with nucleoside analogues at least one week beforechemotherapy can obviously reduce the incidence of HBV reactivation.