Investigation And Analysis Of Risk Factors In The Treatment Of Hepatitis B Virus Reactivation Patients With Immunosuppressive Agents

Objective:To investigate the immunosuppressive treatment of hepatitis B virus reactivation in patients with the status quo,and compare the efficacy and safety of lamivudine and entecavir in treatment of such special populations.To search for and establish an early evaluation system and early warning mechanism for hepatitis B virus reactivation under immunosuppressive therapy.Methods: 1.patients with HBsAg positive or HBsAg negative and HBcAb positive tumors were screened from the medical records system of our hospital with the Information Department of our hospital.A retrospective analysis was performed on the baseline characteristics,chemotherapy regimens,antiviral regimens,biochemical markers,and clinical outcomes of this particular population.2.according to the situation of antiviral therapy were divided into two groups: lamivudine treatment group and entecavir treatment group.Baseline information of patients,serum and biochemical samples were collected.Adverse events were observed in each group,as well as the prognosis and clinical outcomes between the two groups.Regression analysis of single factor and multi factor 3 and influence on the prognosis of patients with the clinical outcome of information,and actively explore the factors of therapeutic efficacy and clinical outcome of the establishment of the initial evaluation system for such special populations and early warning mechanism,were recorded in patients during clinical research in all kinds of adverse events.Result:1.The patients with HBsAg positive or HBsAg negative but anti-HBc positive who received immunosuppressive agents or chemotherapy,the incidence of HBVr in patients with a total of 33 cases,accounting for 13.86%,no HBVr occurred in the case of,accounting for 86.13.A total of 4 departments involved in the 27 diseases.One of the basic diseases of the blood system disease crowd stood at 73%.There are many kinds of chemotherapy regimens,which are divided into four categories.That is,the first class: chemotherapy containing B lymphocyte monoclonal antibody or TNF-alpha inhibitors(such as: R-CHOP,COP+INF+R);second class: containing corticosteroids or alkylating agent solutions(such as: CHOP,Hyper-CVAD,CHOPE,FC;plan)third categories: containing antimetabolitas scheme(such as: DA,CAG etc.);fourth categories: platinum containing antibiotics or chemotherapy scheme(such as: ABVD,SOX etc.);fifth class: other(such as TGP and hydroxychloroquine).Which involves containing corticosteroids and alkylating agent with the most.Antiviral therapy,198 patients received immunosuppressive therapy at least one week before the immunosuppressant or chemotherapy,accounting for 83.19% of the total number of participants.Among them,106 cases of lamivudine,entecavir in 73 cases,3 cases of telbivudine,5 cases of adefovir,lamivudine and adefovir in 7 cases,4 cases of entecavir combined with adefovir dipivoxil.In the week before chemotherapy,antiviral therapy was still 17 of HBVr,accounting for about 7.14% of the patients,most of which were caused by LAM.At the same time,we made some further statistics on the part of the time to stop the antiviral drugs to HBVr,and found that the shortest time for HBVr was 1 months,and the longest was about 11 months.There was one patient after chemotherapy,continue to use antiviral for up to 16 months,after withdrawal of HBVr.2.Immunosuppression or chemotherapy before starting lamivudine or entecavir in patients with a total of 176 cases.The lamivudine group was 104 cases,accounting for 59.09%,entecavir group was 74 cases,accounting for 40.09%.There was no significant difference between the two groups in baseline information,such as transaminase,total bilirubin,HBV DNA negative patients.104 patients with lamivudine,a total of 9 patients were resistant,the resistance ratio was 8.65%,72 cases of entecavir entecavir group of patients,only one patient had drug resistance,drug resistance and the ratio of 1.38%,which was statistically significant(P<0.03).However,the entecavir group HBVr patients,4 patients because of self withdrawal due to HBVr,it is not due to poor outcome in ETV.3.The occurrence of HBVr were analyzed by Logisitc regression,included gender,age,total bilirubin,alanine aminotransferase,HBV markers and HBV level of DNA,a total of 8 factors in advance for antiviral therapy and chemotherapy regimens.Through the single factor and multi factor analysis,it was found that the three factors,such as anti-virus intervention,chemotherapy and HBVDNA baseline,were closely related to the occurrence of HBVr.The scoring system of HBVr risk was established,with a total score of 17 points.Among them,no antiviral therapy and A chemotherapy and HBV DNA more than 104copies/ml and other factors to cause the risk factors of HBVr before chemotherapy.Conclusion:1.Immunosuppressive therapy under the reactivation of hepatitis B virus is a serious clinical problem and the progress of disease onset occult,rapid,poor prognosis as its main features,especially with HBsAg positive anti-HBc positive,need powerful immunosuppressant,such as blood system in patients with malignant tumor cell B monoclonal antibody for chemotherapy.2.Antiviral drugs can effectively reduce or avoid the occurrence and development of HBVr,but for a long-term demand or accept chemotherapy,potent immunosuppressive therapy in high risk population of HBVr,it is suggested that high resistance barrier,antiviral ability than before antiviral drugs.3.For this kind of special crowd,it is important to establish an effective management model,a model and a reasonable evaluation system.