Reactivation of Occult HBV Infection after Allogeneic Hematopoietic Stem Cell Transplantation in HBsAg-negative and Anti-HBs-positive Patients: High Risk in Lymphoid Malignancies and Indication for Pre-emptive Antiviral Therapy

B型肝炎表面抗原陰性抗體陽性之病人異體造血幹細胞移植後潛伏感染的B型肝炎再活化：淋巴性癌症病人為高危險群應接受先制抗病毒治療

劉嘉仁(Chia-Jen Liu) ； 高志平(Jyh-Pyng Gau) ； 劉俊煌(Jin-Hwang Liu) ； 徐會棋(Hui-Chi Hsu) ； 曾成槐(Cheng-Hwai Tzeng)

《台灣癌症醫學雜誌》 26卷5期 (2010/10) Pp. 21-25

https://doi.org/10.6323/JoCRP.2010.26.5.4

摘要

血清有B型肝炎（HBV）表面抗體的病人可能仍有B型肝炎潛伏感染。免疫抑制可使B型肝炎表面抗體濃度下降，導致病毒複製引發肝炎。我們提出 5個 B型肝炎表面抗體陽性且抗原陰性的病人，他們在異體造血幹細胞移植（HSCT）後產生逆向血清轉化（reverse seroconversion）及肝炎活化。淋巴系癌症的病人屬於高危險群，原因可能是淋巴系癌症常會有免疫失序及使用類固醇。這類病人應定期追蹤血清B型肝炎表面抗體，其消失常為逆向血清轉化及肝炎發作的警鐘，應檢測B型肝炎病毒量並給予先制（preemptive）抗病毒治療來預防。

關鍵字

B型肝炎 ； 血液幹細胞移植 ； 抗病毒治療

並列摘要

Hepatitis B virus (HBV) may persist as an occult infection after primary infection despite the emergence of anti-HBs antibody in serum. Immune suppression with gradually reduced titer of anti-HBs can result in enhanced viral replication with development of hepatitis. Here we report 5 patients with positive anti-HBs antibody while negative for HBsAg in serum which developed reverse seroconversion and reactivation of hepatitis after allogeneic hematopoietic stem cell transplantation (HSCT). Patients with lymphoid malignancies are especially at high risk of this complication, probably related to inherently dysregulated immunity in lymphoid malignancies and steroid use during treatment. These patients should be regularly followed for their serum HBsAb after allogeneic HSCT. Disappearance of HBsAb often portends the development of reverse seroconversion and ensuing flare-up of hepatitis. Determination of HBV viral load and preemptive antiviral therapy is indicated for this group of patients to prevent development of full-blown diseases.

並列關鍵字

hepatitis B ； hematopoietic ； stem cell transplantation ； antiviral therapy