临床预测失败，拉米夫定预防B型肝炎感染接受细胞毒性化疗

肝胆速递

Source: Antimicrob Agents Chemother  |  Posted 4 days ago
Clinical prediction of failure of lamivudine prophylaxis for patients with hepatitis B infection undergoing cytotoxic chemotherapy for malignancy; Kim IK, Kim BG, Kim W, Kim D, Kim YJ, Yoon JH, Lee HS; Antimicrobial Agents & Chemotherapy (Aug 2012)

   
Although lamivudine (LAM) prophylaxis is recommended for patients infected with hepatitis B virus (HBV) undergoing chemotherapy for malignant disease, HBV reactivation sometimes occurs during or after LAM administration. The aim of this study was to determine predictors of LAM prophylactic failure in patients with malignancies. Patients with malignancies were routinely screened for serum hepatitis B surface antigen (HBsAg) from June 2002 to August 2008. All consecutive, HBsAg-positive patients received LAM prophylaxis during and after completion of chemotherapy. We assessed risk factors for virologic breakthrough and withdrawal hepatitis. Death without HBV reactivation was regarded as a competing risk event, which was adjusted by the Fine and Gray's model. A total of 110 patients were included in this study. They received LAM prophylaxis for a median of 9.2 months. Virologic breakthrough occurred in 15 patients at a median of 10.9 months from the initiation of LAM prophylaxis. Withdrawal hepatitis occurred in 15 patients at a median of 2.4 months after cessation of LAM prophylaxis. Multivariable analysis showed that high baseline HBV DNA titer (≥2,000 IU/mL) (HR, 9.94; P=.0063) and the use of rituximab (HR, 3.19; P=.027) were significant predictors of virologic breakthrough and that high baseline HBV DNA titer (HR, 5.90; P=.007), liver cirrhosis (HR, 10.4; P=.002), and distant metastasis (HR, 5.14; P=.008) were independent risk factors for withdrawal hepatitis. Patients with high viremia, liver cirrhosis, rituximab treatment, and distant metastasis are at high risk of prophylactic failure and need antiviral agents with a greater barrier to resistance.

肝胆速递

来源：抗生素杂志|发表于4天前
临床预测失败，拉米夫定预防B型肝炎感染接受细胞毒性化疗的恶性肿瘤患者
尹金YJ金金宽，金益，金BG，D，JH，李HS;
抗微生物制剂和化疗（2012年8月）


虽然接受化疗治疗恶性疾病与乙型肝炎病毒（HBV）感染的患者，HBV拉米夫定（LAM）预防建议重新启动，有时会发生期间或之后，林管理。本研究的目的是确定在恶性肿瘤患者的林预防性故障的预测。癌症患者进行例行检查，血清乙肝表面抗原（HBsAg），从2002年6月至2008年8月。期间及化疗结束后，所有连续的，乙肝表面抗原阳性的患者接受LAM预防。我们评估的病毒学突破和退出肝炎的风险因素。无HBV再激活的死亡被认为是一个竞争的风险事件，这是由精细调整和灰色模型。在这项研究中，共有110例患者被纳入。林预防的中位数为9.2个月。病毒学突破发生在15例患者在中位数为10.9个月，从开始的林预防。退出肝炎发生的15例患者中位数为2.4个月后停止LAM预防。多变量分析表明，高基线HBV DNA滴度（≥2000 IU / mL）中（HR，9.94，P = 0.0063），并使用利妥昔单抗（HR，3.19; P = .027）病毒学突破和显着的预测基线HBV DNA滴度（HR，5.90; P = 0.007），肝硬化（HR，10.4，P = 0.002）和远处转移（HR，5.14; P = 0.008）撤回肝炎的独立危险因素。高病毒血症，肝硬化，利妥昔单抗治疗，和远处转移的患者在高风险的预防性故障，需要抗病毒药物具有更大的障碍性。