Reactivation of hepatitis B virus after glioblastoma treatment with temozolomide--case report.
Reactivation of hepatitis B virus after glioblastoma treatment with temozolomide--case report.
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替莫唑胺治疗胶质母细胞瘤后乙型肝炎病毒重新激活——病例报告。
DOI：
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发表时间：
2011
影响因子：
1.9
通讯作者：
S. Shibui
中科院分区：
文献类型：
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作者：
M. Ohno;Y. Narita;Y. Miyakita;H. Ueno;T. Kayama;S. Shibui
一名患有胶质母细胞瘤、乙型肝炎表面抗原（HBsAg）阳性的61岁男性患者在术后接受替莫唑胺（75 mg/m(2)/天）和放射治疗（30次60 Gy）后，因乙型肝炎病毒（HBV）再活化而发生急性肝炎。化疗期间未使用皮质类固醇，观察到4级淋巴细胞减少。肝功能测试（LFTs）水平，包括天冬氨酸转氨酶和丙氨酸转氨酶水平，在化疗-放疗完成5周后增加，并在2周后分别达到1,549 IU/l（正常13至33 IU/l）和1,653 IU/l（正常8至42 IU/l）的最高水平。此时，血清hbv -脱氧核糖核酸（DNA）水平已增加到基线水平的630倍，并开始使用抗病毒药物恩替卡韦（每天0.5 mg）治疗。在接下来的2周内，LFTs和HBV-DNA水平有所改善。目前和以前的病例表明，3/4级淋巴细胞减少症或2级淋巴细胞减少症合并皮质类固醇可能对HBV再激活有显著影响。为了避免这种并发症，hbsag阳性的胶质母细胞瘤患者在替莫唑胺治疗前应咨询肝病专家开始抗病毒治疗。
A 61-year-old man with glioblastoma and positive for hepatitis B surface antigen (HBsAg) developed acute hepatitis due to hepatitis B virus (HBV) reactivation after concomitant postoperative treatment with temozolomide (75 mg/m(2)/day) and radiation therapy (60 Gy in 30 fractions). Corticosteroids were not used during chemo-radiation therapy, and grade 4 lymphocytopenia was observed. The levels of liver function tests (LFTs), including levels of aspartate aminotransferase and alanine aminotransferase, increased 5 weeks after the completion of chemo-radiation therapy, and reached the maximum levels of 1,549 IU/l (normal 13 to 33 IU/l) and 1,653 IU/l (normal 8 to 42 IU/l), respectively, after 2 weeks. At this point, serum HBV-deoxyribonucleic acid (DNA) level had increased to 630-fold over the baseline, and therapy with the antivirus agent entecavir (0.5 mg daily) was started. Over the next 2 weeks, the levels of LFTs and HBV-DNA improved. The present and previous cases suggest that grade 3/4 lymphocytopenia or grade 2 lymphocytopenia with corticosteroid use might have a significant effect on HBV reactivation. To avoid this complication, HBsAg-positive patients with glioblastoma should consult a hepatologist for initiating antivirus therapy before temozolomide treatment.