- 期刊
化療導致B肝病毒活化的預防與治療
Prevention and Management of Hepatitis B Virus Reactivation in Cancer Patients Undergoing Chemotherapy
摘要
B型肝炎帶原之癌症患者，於化療(chemotherapy)期間除了面臨癌症所受的痛苦之外，又必須承擔B肝病毒活化(hepatitis B virus reactivation)所帶來的危機。在此，提出如何預防與治療B肝病毒的活化；並分析導致B肝病毒活化之各種危險因子。依實證醫學之建議：預防性、先給予干安能(preemptive lamivudine)，可以明顯減少B肝病毒之活化，避免失償性肝炎，減少中斷化療的機會。因此，在化療前，建議開始給藥；直到化療結束後，至少再延續3個月的干安能(lamivudine)。停藥前後，必須再三評估其免疫、造血功能(CBC/DC)是否恢復，並檢查ALT & HBV-DNA濃度。至於YMDD突變與停藥後的反彈性肝炎(lamivudine withdrawal hepatitis)，只要提高警覺並定期追蹤檢查即可。由於台灣為B型肝炎盛行區，成人需化療患者有10-15%為B型肝炎帶原者，因此於化療前都應該檢測HBsAg，以提高警覺並避免療程中肝炎復發。
並列摘要
For cancer patients receiving cytotoxic chemotherapy, hepatitis B virus reactivation is well-described complication resulting in varying degree of liver damage. Therefore, we discuss how to prevent and manage the HBV reactivation in cancer patients undergoing chemotherapy; analyze the risk factors of HBV reactivation. According to the evidence-base medicine: The prophylactic, preemptive lamivudine significantly decreases the incidence of HBV reactivation, morbidity and disruption of chemotherapy. So the HBsAg or HBV-DNA positive patients are recommended the preemptive lamivudine before initiation of chemotherapy. The treatment was then continued throughout the course of chemotherapy for at least 3 months after discontinuation of chemotherapy and when the total white cell counts had become normalized. If the physician and patient do regular follow up carefully, it is not difficult to deal with the YMDD mutation and withdrawal hepatitis after cessation of preemptive lamivudine.
延伸閱讀
- 張建林、李懿宬（2023）。B型肝炎口服抗病毒藥物治療下肝癌的發生與復發風險。臨床醫學月刊，91(2)，103-108。https://doi.org/10.6666/ClinMed.202302_91(2).0018
- 曾光毅、曾嵩智（2004）。現階段B型肝炎的預防與治療。基層醫學，19(1)，19-25。https://doi.org/10.6965/PMCFM.200401.0019
- 廖運範（2003）。慢性B型肝炎（二）處置與治療。當代醫學，(353)，173-181。https://doi.org/10.29941/MT.200303.0003
- Chuang, W. L., Chang, W. Y., Lu, S. N., Lin, Z. Y., Chen, S. C., Hsieh, M. Y., Wang, L. Y., Wu, C. C., Chang, S. F., & Chow, T. Y. (1987). Hepatitis D Virus Infection in Patients with Chronic Hepatitis B Virus Infection. The Kaohsiung Journal of Medical Sciences, 3(2), 121-127. https://doi.org/10.6452/KJMS.198702.0121
- Lok, S. F. (1990). Replication of hepatitis B virus in Chinese patients with chronic hepatitis B virus infection [master's thesis, The University of Hong Kong]. Airiti Library. https://www.airitilibrary.com/Article/Detail?DocID=U0029-1812201200002185