A randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo-lipiodolization
A randomized controlled study of preemptive lamivudine in patients receiving transarterial chemo-lipiodolization
复制标题
DOI：
10.1002/hep.21024
复制
发表时间：
2006-02-01
期刊：
影响因子：
13.5
通讯作者：
Lee, YS
中科院分区：
文献类型：
--
作者：
Jang, JW;Choi, JY;Lee, YS
化疗期间乙型肝炎病毒（HBV）的再激活是有充分证据的。然而，在接受经动脉化疗的肝细胞癌（HCC）患者中，这种并发症的数据有限。本研究的目的是评估预防性拉米夫定治疗在减少肝细胞癌经动脉化疗-脂质化（TACL）患者HBV再活化肝炎中的疗效，并寻求这一事件的预测因素。共有73例连续接受TACL的HCC患者，每月使用表柔比星50 mg/m(2)和顺铂60 mg/m(2)，前瞻性和随机分配，从TACL开始每天服用100 mg拉米夫定（先发制人组）或不服用拉米夫定（对照组）。在研究期间，对照组37例患者中有11例（29.7%）发生HBV再活化肝炎，而先发制人组36例患者中有1例（2.8%）发生HBV再活化肝炎（P = 0.002）。此外，对照组肝炎总发生率（P = 0.021）和重度肝炎发生率（P = 0.035）明显高于对照组。通过多变量Cox回归模型，基线HBV DNA水平超过10(4)拷贝/mL是化疗-脂化过程中HBV再激活引起肝炎的唯一独立预测因子（P = 0.046）。总之，先发制人的拉米夫定治疗在减少TACL期间HBV再活化引起的肝炎和肝脏发病率方面表现出优异的疗效。对于HBV DNA水平超过10(4)拷贝/mL的HCC患者，应考虑先发制人治疗。需要进一步的研究来证实这种方法在低水平病毒血症患者中的价值。
Reactivation of hepatitis B virus (HBV) during chemotherapy is well documented. However, there are limited data on this complication in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemotherapy. The aim of this study was to evaluate the efficacy of preemptive lamivudine therapy in reducing hepatitis due to HBV reactivation in patients with HCC undergoing transarterial chemo-lipiodolization (TACL) and to seek predictors of this event. A total of 73 consecutive HCC patients undergoing TACL using epirubicin 50 mg/m(2) and cisplatin 60 mg/m(2) at monthly intervals were prospectively and randomly assigned to receive lamivudine 100 mg daily from the start of TACL (preemptive group) or not (control group). During the study, 11 (29.7%) of 37 patients in the control group and 1 (2.8%) of 36 patients in the preemptive group developed hepatitis due to HBV reactivation (P = .002). In addition, there were significantly more incidences of overall hepatitis (P = .021) and severe grade of hepatitis (P = .035) in the control group. With multivariate Cox regression model, a baseline HBV DNA level of more than 10(4) copies/mL was the only independent predictor of hepatitis due to HBV reactivation during chemo-lipiodolization (P = .046). In conclusion, preemptive lamivudine therapy demonstrated excellent efficacy in reducing hepatitis due to HBV reactivation and hepatic morbidity during TACL. Preemptive therapy should be considered in HCC patients with an HBV DNA level of more than 10(4) copies/mL. Further studies are needed to confirm the value of this approach in patients with low-level viremia.