HBsAb/HBeAb/HBcAb陽性多發性骨髓瘤化療后HBV再激活1例并文獻復習

張春蘭　陳茂偉

[摘要] 乙肝再激活通常發生在慢性乙型病毒性肝炎感染患者在接受腫瘤化療或免疫治療過程中，但發生抗-HBs陽性患者中少見。本文報道1例65歲HBsAb陽性男性患者因診斷“多發性骨髓瘤”長期接受（硼替佐米/阿霉素/地塞米松/雷納度胺）化療，既往無肝病病史，化療前及化療期間多次查HBV血清標志物提示HBsAg、HBeAg均陰性，HBsAb、HBeAb、HBcAb均陽性，化療6周期后出現乙肝再激活，HBVDNA回報為 2.46×106 IU/mL，經護肝、退黃、修復受損肝細胞、人工肝血漿置換等內科綜合治療病情好轉出院。

[關鍵詞] 抗-HBs陽性;乙肝再激活;多發性骨髓瘤;免疫抑制藥物

[中圖分類號] R446.6 ? ? ? ? ?[文獻標識碼] C ? ? ? ? ?[文章編號] 1673-9701（2020）21-0164-03

A case report and literature review of HBV reactivation after multiple myeloma chemotherapy in HBsAb/HBeAb/HBcAb-positive patients

ZHANG Chunlan ? CHEN Maowei

Department of Infectious Diseases， Wuming Hospital Affiliated to Guangxi Medical University， Wuming ? 530199， China

[Abstract] Hepatitis B reactivation usually occurs in patients with chronic hepatitis B infection during tumor chemotherapy or immunotherapy. But it is rare in anti-HBs positive patients. This article reports that a 65-year-old HBsAb-positive male patient received long-term chemotherapy（bortizomil/adriamycin/dexamethasone/renalidomide） for the diagnosis of "multiple myeloma"， with no previous history of liver disease. Multiple examinations of HBV serum markers indicated that HBsAg and HBeAg were negative， and HBsAb， HBeAb， and HBcAb were positive before and during chemotherapy. Hepatitis B reactivation occurred after 6 cycles of chemotherapy. The HBV DNA was 2.46×106 IU/mL. The patient was discharged from the hospital after comprehensive medical treatment such as liver protection， retreat yellow， repair of damaged hepatocytes， and artificial liver plasma replacement.

[Key words] Anti-HBs positive; Hepatitis B reactivation; Multiple myeloma; Immunosuppressive drugs

乙型肝炎病毒（Hepatitis B virus，HBV）再激活是指慢性HBV感染者在接受腫瘤化療或免疫抑制劑治療過程中出現不同程度的乙型肝炎再活動，病情嚴重者出現急性肝衰竭甚至死亡，另一方面也可導致針對接受腫瘤化療或免疫抑制劑的有效治療中斷，從而影響患者生存及預后。近年來，隨著各類靶向藥物及免疫抑制藥物研發與應用，與血液系統相關的腫瘤治療取得了突破性進展，出現化療后HBV再激活病例數量不斷增加。但乙肝保護性抗體的患者在接受化療或免疫抑制治療出現乙肝再激活病例少見，現報道1例一抗-HBs陽性HBV再激活病例，以提高臨床醫生對該少見情況的認識，現報道如下。

1 病例資料

患者，男，65歲。因“發現腰背部脹痛1年余”于2017年6月8日入院。患者自訴2016年6月始自覺腰背部脹痛，無放射痛，活動后可加重，無鼻出血、牙齦出血，無頭暈、眩暈、肢體麻木，無血尿、腹脹、腹瀉，無胸悶、呼吸困難等不適。……