利妥昔单抗联合化疗致HBsAg(-)/HBcAb(+)者HBV再激活1例并文献复习

HBV Reactivation in Patients with HBsAg(-)/HBcAb(+) Induced by Rituximab Combined with Chemotherapy: A Case Report and Literature Review

摘要: 目的：研究HBsAg(-)/HBcAb(+)者接受利妥昔单抗联合化疗时发生HBV再激活的临床表现、发病机制、影响因素及防治措施，以期引起临床医师对免疫抑制剂致HBV再激活的重视。方法：报告1例HBsAg(-)/HBcAb(+)合并淋巴瘤患者接受利妥昔单抗联合化疗后HBV再激活的临床表现和诊治过程，并进行文献复习，分析其发病机制和影响因素。结果：患者接受利妥昔单抗相关治疗前HBsAg(-)/HBcAb(+)，HBV DNA低于检测下限(<1 × 10³ IU/ml)，肝功能正常，未进行预防性抗病毒治疗。接受利妥昔单抗相关治疗后相继出现HBsAg、HBV DNA转阳，肝功能异常，经恩替卡韦抗病毒，保肝、抗炎治疗后，好转出院。出院后继续口服恩替卡韦抗病毒治疗，5年后获得临床治愈。结论：HBsAg(-)/HBcAb(+)者，在接受利妥昔单抗等B细胞单克隆抗体治疗时，HBV再激活风险高，应预防性抗病毒治疗。

Abstract: Purpose: To explore clinical manifestations, pathogenesis, infuencingfactors, prevention and treatement of HBV reactivation in HBsAg(-)/HBcAb(+) patients receiving rituximab combined with chemotherapy, in order to attract clinicians’ attention to HBV reactivation. Methods: To report the clinical manifestations, diagnosis and treatment of HBV reactivation induced by rituximab combined with chemotheray in the patent with HBsAg(-)/HBcAb(+) and lymphoma, and review the literature to analyze its pathogenesis and influencing factors. Result: The patient’s hepatitis B serology is HBsAg(-)/HBcAb(+), HBV DNA load below lower limit of detection, and normal liver function before receiving rituximab therapy. When receiving immunosuppressive therapy without prophylactic antiviral therapy, the patient has HBsAg, HBV DNA became positive, and ALT level increased. After antiviral therapy and symptomatic and supportive treatment, the patient discharged finally. He continued antiviral therapy after discharge and clinical cure was achieved after 5 years. Conclusion: The risk of HBV reactivation in patients receiving anti-20 monoclonal antibodies with HBsAg(-)/HBcAb(+) is higher, we recommend using antiviral prophylaxis therapy.