乙肝病毒感染和乳腺癌化疗后肝损害相关因素分析

Analysis of Related Factors for Hepatic Toxicity in Breast Cancer with Hepatitis B Virus Infection during Chemotherapy

关键词:  乳腺癌  乙型肝炎病毒  化疗  肝损害

Key words:  breast cancer  hepatitis B virus  chemotherapy  hepatic toxicity

摘要:

目的 探讨乙型肝炎病毒(hepatitis B virus, HBV)感染对乳腺癌患者化疗后肝损害的影响及其它危险因素。方法 应用ELISA法检测HBV感染乳腺癌454例的乙肝五项指标并常规检测肝功能，以同期住院的未感染HBV乳腺癌454例设为对照组进行比较。结果 HBV感染组化疗2，4，6周期后1~4级肝损害发生率分别为22.9%，31.1%，25.9%，对照组分别是24.7%，25.4%，20.8%，两组差异无统计学意义；≥2级肝损害发生率分别是3.3%，6.9%，2.7%，对照组分别是4.6%，1.9%，1.9%，两组化疗4周期后≥2级肝损害发生率差异有统计学意义(χ²=12.902，P=0.000)，化疗2、6周期后≥2级肝损害发生率差异无统计学意义。36～55岁(P=0.001)、CAF→T方案(P=0.004)、脂肪肝(P=0.035)和糖皮质激素(P=0.001)等因素组的HBV感染乳腺癌患者≥2级肝损害发生率与对照组均有明显差异。HBV激活17例(17/454,3.7%)，肝损害均≥2级(17/17,100%)。结论 HBV感染的乳腺癌患者化疗后1~4级肝损害的发生率与未感染者无明显差异；化疗4周期后≥2级肝损害发生率HBV感染者明显高于未感染者。36~55岁、CAF→T方案、脂肪肝和糖皮质激素等因素与HBV感染的乳腺癌患者化疗后≥2级肝损害有关。

Abstract:

OBJECTIVE To study the incidence and related factors for hepatic toxicity in breast cancer with HBV infection during chemotherapy. METHODS We used ELISA to detect the serum markers of HBV and liver function in 908 breast cancer patients. Serum HBV DNA was quantified by PCR-fluorescence probing. The hepatic toxicity was analyzed with regard to toxicity according to CTCAE v. 4.03. RESULTS After 2, 4, 6 course of chemotherapy, the incidences of grade 1-4 hepatic toxicity were 22.9%, 31.1%, 25.9% and 24.7%, 25.4%, 20.8%, respectively in breast cancer with and without HBV infection(P=0.533, P=0.061, P=0.085); ≥grade 2 were 3.3%, 6.9%, 2.7% and 4.6%, 1.9%, 1.9%, respectively in breast cancer with and without HBV infection(P=0.395, P=0.000, P=0.491). Development of ≥grade 2 hepatic toxicity for breast cancer with HBV infection was significantly more common in the 36-55 years(P=0.001), CAF→T(P=0.004), fatty liver(P=0.035) and steroid(P=0.001). HBV reactivation was obtained in seventeen breast cancer patients with HBV infection during chemotherapy. All of them had developed ≥grade 2 hepatic toxicity. CONCLUSION HBV infection was more likely to cause patients with breast cancer to develop ≥grade 2 hepatic toxicity after four courses of chemotherapy. 36-55 years, CAF→T, fatty liver and steroid were associated with higher risk of ≥grade 2 hepatic toxicity in breast cancer patients with HBV infection during chemotherapy.