Evaluating the risk of hepatitis B reactivation in patients with haematological malignancies: is the serum hepatitis B virus profile reliable?
Evaluating the risk of hepatitis B reactivation in patients with haematological malignancies: is the serum hepatitis B virus profile reliable?
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DOI：
10.1111/j.1478-3231.2009.02071.x
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发表时间：
2009-09-01
影响因子：
6.7
通讯作者：
Di Stefano, Rosa
中科院分区：
文献类型：
--
作者：
Ferraro, Donatella;Pizzillo, Paola;Di Stefano, Rosa
背景/目的隐匿性乙型肝炎病毒 (HBV) 感染且接受深度免疫抑制的患者可能面临 HBV 再激活的风险。为了评估血清中 HBV DNA 的聚合酶链反应 (PCR) 测定是否可用于预测隐匿性 HBV 感染的重新激活，我们对一组西西里患有肿瘤血液疾病的患者进行了回顾性研究。方法我们通过高度敏感的特设巢式 PCR 对血清 HBV DNA 进行了研究，对 75 名需要化疗的 HBsAg 阴性肿瘤血液患者进行了研究。结果 33 名患者 (44%) 为 HBV血清阴性（抗 HBc 和抗 HBs 阴性），42 名患者 (56%) HBV 血清阳性（抗 HBc 和/或抗 HBs 阳性）。 33 名 HBV 血清阴性患者中的 9 名和 42 名 HBV 血清阳性患者中的 9 名基线血清 HBV DNA 呈阳性（27.3% vs. 21.4%；P=NS）。 33 名血清阴性患者中有 5 名观察到 HBsAg 血清转换，而 42 名血清阳性患者中有 6 名观察到 HBsAg 血清转换（15% vs. 14%，P=0.9）；18 名 HBV DNA 阳性患者中有 5 名 vs 57 名 HBV DNA 阴性患者中有 6 名出现 HBsAg 血清转换（27.7% vs. 10.6% P=0.11）。 18 名患者 (24.3%) 发现丙型肝炎病毒感染，尽管与 HBV 血清学状态、血清 HBV DNA 存在或 HBsAg 血清转换频率无关。结论在接受化疗的肿瘤血液学患者中，基线时高灵敏度血清 HBV DNA 检测对 HBV DNA 阳性患者的 HBsAg 血清转换有 28% 的预测能力，对持续 HBsAg 的预测能力有 90% HBV DNA阴性患者的阴性结果比血清学检测的表现更好。
Background/AimPatients with an occult hepatitis B virus (HBV) infection undergoing deep immunosuppression are potentially at risk of HBV reactivation. In order to assess whether a polymerase chain reaction (PCR) assay for HBV DNA in serum could be used to predict the reactivation of an occult HBV infection, we performed a retrospective study in a cohort of Sicilian patients with oncohaematological diseases.MethodsWe studied by a highly sensitive ad hoc nested PCR for serum HBV DNA 75 HBsAg-negative oncohaematological patients requiring chemotherapy.ResultsThirty-three patients (44%) were HBV seronegative (anti-HBc and anti-HBs negative) and 42 patients (56%) were HBV seropositive (anti-HBc and/or anti-HBs positive). Baseline serum HBV DNA was positive in nine out of 33 HBV-seronegative patients and in nine out of 42 HBV-seropositive patients (27.3 vs. 21.4%; P=NS). HBsAg seroconversion was observed in five out of 33 seronegative vs. six out of 42 seropositive patients (15 vs. 14%, P=0.9), and in five out of 18 HBV DNA-positive vs. six out of 57 HBV DNA-negative patients (27.7 vs. 10.6% P=0.11). Hepatitis C virus infection was found in 18 patients (24.3%), although with no correlation to HBV serological status, presence of serum HBV DNA or frequency of HBsAg seroconversion.ConclusionsIn oncohaematological patients undergoing chemotherapy, highly sensitive serum HBV DNA testing at baseline has a 28% predictive ability to forecast HBsAg seroconversion in HBV DNA-positive patients, and a 90% ability to forecast persistent HBsAg negativity in HBV DNA-negative patients, a better performance than serological tests.