Tumour Biol：广州中山三院吴祥元等发现抗病毒优化策略可预防HBV再激活

乙型肝炎病毒（HBV）感染是我国原发性肝癌的主要病因，近年来，与化疗相关的HBV再激活引起全球广泛关注。预防性应用核苷酸类似物，包括拉米夫定（LAM）等，已被证明可有效预防化疗患者发生HBV再激活。然而，对于接受LAM预防性用药及化疗的患者来说，如果不清楚HBV再激活的潜在因素且缺乏优化管理，那么仍然无法从根本上消除HBV再激活。
基于上述情况，我国广州中山大学附属第三医院肿瘤内科主任吴祥元等人展开一项研究，研究结果发表于《肿瘤生物学》（Tumour Biology）杂志2013年4月版。作者发现，采用优化的抗病毒改良策略可有效抑制出现病毒学突破或复发患者发展为HBV再激活。
根据先前的研究，研究人员高度怀疑病毒学突破及复发是导致HBV再激活的潜在病毒学因素。因此，他们回顾分析了既往的24项研究，一共包括447例接受化疗和LAM预防性用药的患者，这些患者的HBV再激活率为7.2%。以往的研究很少探讨病毒学突破及复发对HBV再激活的影响。此外，作者还将在其中心接受LAM预防性治疗及化疗的另外72例患者也被一同纳入分析。
研究结果如下：在这些患者中，8例患者发展为病毒学突破，另外9例在停用LAM后出现病毒复发。其中，8例患者接受改良的抗病毒治疗方案，包括发生病毒学突破的患者服用阿德福伟治疗，或者是病毒复发的患者重新接受LAM治疗，这些患者无一发展为HBV再激活。相反，在9例没有接受改良抗病毒治疗方案的患者中，有6例发展为HBV再激活，2例死亡。
综上所述，这项研究表明，对于接受化疗或LAM预防性用药的患者来说，病毒学突破和复发是导致HBV再激活的关键因素。采用改良的抗病毒优化策略可有效抑制出现病毒学突破或复发患者发展为HBV再激活。

An optimized antiviral modification strategy for prevention of hepatitis B reactivation in patients undergoing prophylactic lamivudine and chemotherapy: a pilot study.
Abstract
In patients receiving prophylactic lamivudine (LAM) and chemotherapy, hepatitis B virus (HBV) reactivation cannot be eliminated without knowing the latent causes and optimal management. In our previous study, virus breakthrough and relapse were highly suspected as potential virologic causes for HBV reactivation. Therefore, we reviewed 24 previous studies and 447 patients who underwent chemotherapy and prophylactic LAM, with an incidence of 7.2 % HBV reactivation. Virus breakthrough and relapse were seldom investigated in these studies. In addition, 72 patients that underwent prophylactic LAM and chemotherapy at our centers were also analyzed. Among them, eight patients developed virus breakthrough, with another nine developing virus relapse after discontinuation of LAM. Eight patients received antiviral modification, which included administration of adefovir for patients with virus breakthrough or resumption of LAM for patients with virus relapse and none of them developed HBV reactivation. In contrast, of the nine patients who did not receive antiviral modification, six developed HBV reactivation and two died. In conclusion, this study demonstrated that virus breakthrough and relapse were the critical causative factors of HBV reactivation in patients receiving chemotherapy and prophylactic LAM. An optimized antiviral modification strategy could effectively prevent HBV reactivation in patients with virus breakthrough or relapse.