拉米能够预防E阳性病人中HBV化学治疗诱发的肝损伤 (hepwatch 2005-2-7)

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HEPATOCELLULAR CARCINOMA (HCC)

Effectiveness of prophylactic lamivudine administration. Previous studies have shown that HBeAg positivity was associated with exacerbation of liver damage in patients with HBV-related HCC who were treated with transhepatic arterial infusion chemotherapy (THAIC). In the current study, Hiroaki Nagamatsu et al. retrospectively investigated the effect of prophylactic lamivudine therapy in 8 patients with HBV-related HCC who were treated at the Kurume University Hospital in Japan with THAIC from 2000 to 2002. Lamivudine 100 mg daily was administered for an average of 28 days prior to chemotherapy and throughout chemotherapy. All 8 patients were HBsAg+ and HBeAg+. Nine HBeAg+ patients with HBV-related HCC who received THAIC from 1993 to 1999 without lamivudine prophylaxis served as historical controls. Lamivudine therapy resulted in significant reductions of HBV DNA levels. Increases in ALT, AST, and total bilirubin levels and prolongation of prothrombin times occurred in control patients; 6 had exacerbation of liver damage, and 3 died of liver disease due to HBV reactivation. None of the patients given lamivudine prophylaxis developed exacerbation of liver damage. Results in this small study suggest that prophylactic lamivudine therapy may prevent exacerbation of liver damage due to chemotherapy-induced HBV reactivation in HBeAg+ patients. (Nagamatsu H, et al. Am J Gastroenterol 2004;99:2369-2375)