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소화기; 악성 림프종 환자에서 항암화학요법 후 발생하는 B형 간염의 재활성화
장승준 ( Seung Jun Jang ),정영걸 ( Young Kul Jung ),백혜림 ( Hae Lim Baek ),윤현화 ( Hyun Hwa Yoon ),신승각 ( Seung Kak Shin ),홍준식 ( Jun Shik Hong ),박진희 ( Jin Ny Park ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( 대한내과학회 2013 대한내과학회지 Vol.85 No.6
Background/Aims: Reactivation of hepatitis B virus (HBV) has been reported in HBV surface antigen (HBsAg)-positive patients undergoing chemotherapy, as well as HBsAg-negative patients with antibodies against HBV core antigen (HBcAg) and/or HBsAg (HBsAb). Chemotherapy-including rituximab-has recently been identified as a predictive factor for HBV reactivation in HBsAg- negative patients with malignant lymphoma. The aim of our study was to identify the factors predictive of HBV reactivation after chemotherapy in patients with malignant lymphoma. Methods: We conducted a retrospective analysis of medical records from patients diagnosed with malignant lymphoma at Gachon University Gil Medical Center in City, County from January 2005 to December 2010. We subsequently determined HBsAg, HBsAb and anti-HBc status in the 196 patients treated with chemotherapy. Results: The mean age of the patients was 57.3 ± 14.5 years; 56.3% were male. A total of 172 of 196 (88%) patients in the study population were HBsAg (+) prior to chemotherapy. Three patients (3/11, 27.3%) in the HBsAg (+) group had confirmed HBV reactivation after chemotherapy. In addition, 26 of 196 (13%) patients in the study population tested HBcAg (+) positive prior to chemotherapy. One patient (1/15, 6.7%) in the HBsAg (-)/HBcAb (+) group had confirmed HBV reactivation. In the four patients with HBV reactivation, infection was resolved after treatment with 0.5 mg entecavir or 100 mg lamivudine. Conclusions: Reactivation of HBV after systemic chemotherapy can occur in HBsAg (-) patients. We recommend that malignant lymphoma patients undergoing chemotherapy be screened for HBV infection status, including HBcAg, and followed closely to prevent HBV reactivation. (Korean J Med 2013;85:598-603)
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