癌症患者使用免疫检查点抑制剂与乙肝病毒再激活的研究现状
Current Research Status of Hepatitis B Virus Reactivation in Cancer Patients Receiving Immune Checkpoint Inhibitors
摘要: 免疫检查点抑制剂(ICIs)在肿瘤治疗领域取得了革命性突破，然而，对于合并乙型肝炎病毒(HBV)感染的癌症患者而言，ICIs可能引发HBV再激活(HBVr)的风险，同时其潜在的抗病毒作用又构成了一种复杂的“免疫双刃剑”效应。本综述旨在深入探讨这一领域的最新研究进展。ICIs通过阻断PD-1/PD-L1通路恢复HBV特异性T细胞功能，但可能打破肝脏免疫平衡，导致HBV再激活(HBVr)。肝细胞癌患者(尤其接受HAIC + TKI + ICI联合治疗者)风险最高(14.3%)，HBsAg阳性、高病毒载量为高危因素。ICIs在特定条件下或可促进HBsAg清除，体现其“免疫双刃剑”特性。目前血清学阴性者隐匿感染风险、新型免疫疗法影响等争议尚存。未来需通过多学科协作、多组学风险模型及个体化联合策略，平衡抗肿瘤疗效与HBV安全性。
Abstract: Immune checkpoint inhibitors (ICIs) have achieved revolutionary breakthroughs in cancer treatment. However, for cancer patients with hepatitis B virus (HBV) infection, ICIs may trigger the risk of HBV reactivation (HBVr), while their potential antiviral effects constitute a complex “double-edged sword” immune phenomenon. This review aims to provide an in-depth exploration of the latest research advances in this field. ICIs restore HBV-specific T-cell function by blocking the PD-1/PD-L1 pathway but may disrupt hepatic immune homeostasis, leading to HBV reactivation (HBVr). Hepatocellular carcinoma (HCC) patients, especially those receiving combined therapy (e.g., HAIC + TKI + ICI), exhibit the highest risk (14.3%), with HBsAg positivity and high viral load identified as key high-risk factors. ICIs may facilitate HBsAg clearance under specific conditions, highlighting their dual immunomodulatory role. Controversies persist regarding occult infection risks in seronegative patients and the impact of novel immunotherapies. Future efforts should focus on multidisciplinary collaboration, multi-omics risk prediction models, and individualized combination strategies to balance antitumor efficacy and HBV safety.
文章引用：蒋金宏, 秦波. 癌症患者使用免疫检查点抑制剂与乙肝病毒再激活的研究现状[J]. 临床医学进展, 2025, 15(12): 1498-1512. https://doi.org/10.12677/acm.2025.15123558

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