本文選題：乙型肝炎病毒　切入點(diǎn)：再激活　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：乳腺癌患者接受細(xì)胞毒化療可以導(dǎo)致機(jī)體處于潛伏或者靜止?fàn)顟B(tài)的乙型肝炎病毒(hepatitis B virus,HBV)再激活,甚至出現(xiàn)肝組織損傷,臨床可表現(xiàn)為無癥狀自限性肝炎,或暴發(fā)性肝衰竭所致的化療中斷甚至死亡。研究表明,在乙型肝炎表面抗原(hepatitis B surface antigen,HBs Ag)、乙型肝炎核心抗體(hepatitis B core antibody,HBcAb)陽性乳腺癌化療相關(guān)HBV再激活的患者中,HBV再激活率達(dá)14.7%~55.6%,HBV再激活所致的肝炎發(fā)生率達(dá)16%~58.8%,HBV再激活所致的化療中斷率則達(dá)12.7%~71%。HBV再激活的發(fā)病機(jī)理目前尚未完全闡釋明確,通常認(rèn)為是化療藥物導(dǎo)致HBV與機(jī)體之間的免疫失衡;此外,也與化療藥物對(duì)HBV的直接激活有關(guān),其危險(xiǎn)因素涉及HBV病原學(xué)狀態(tài)、HBV DNA載量、HBV共價(jià)閉合環(huán)狀DNA(covalently closed circular DNA,cccDNA)載量、HBV基因突變、HBsAg氨基酸置換以及化療方案、年齡等方面。為了減少乳腺癌化療相關(guān)HBV再激活及其相關(guān)并發(fā)癥的發(fā)生,化療前應(yīng)常規(guī)篩查HBV感染(HBsAg、HBcAb),對(duì)HBs Ag陽性患者建議預(yù)防性給予抗病毒藥物(核苷(酸)類似物);對(duì)HBs Ag陰性、HBcAb陽性患者則建議密切隨訪,及早發(fā)現(xiàn)HBV再激活并啟動(dòng)抗病毒治療。
[Abstract]:Chemotherapy with cytotoxic chemotherapy in breast cancer patients can lead to the reactivation of hepatitis B virus hepatitis B virus (HBV) in latent or stationary state, and even liver tissue damage, which can be characterized by asymptomatic self-limited hepatitis. Or chemotherapy interruptions or even deaths due to fulminant liver failure. In patients with hepatitis B surface antigen-HBs Agna, hepatitis B core antibody HBcAb-positive breast cancer patients with chemotherapy-associated reactivation of HBV, the rate of HBV reactivation was 14.7% and 55.6% respectively. The incidence of hepatitis caused by HBV reactivation was 1658.8%. At present, the pathogenesis of HBV reactivation has not been fully explained. It is generally believed that chemotherapeutic drugs cause immune imbalance between HBV and the body; in addition, it is also related to the direct activation of HBV by chemotherapeutic drugs. The risk factors are associated with HBV DNA load and HBV covalently closed cyclic DNA(covalently closed circular DNA (HBV-DNA) load, the amino acid replacement of HBV-gene mutation and the chemotherapy regimen. In order to reduce the incidence of chemotherapy-related HBV reactivation and related complications in breast cancer, Before chemotherapy, routine screening should be made for HBcAban of HBV infected HBs, and prophylactic administration of antiviral drugs (nucleoside (acid) analogue) should be given to HBsAg positive patients, while for HBsAg negative HBcAb positive patients, close follow-up should be suggested to detect HBV reactivation and initiate antiviral therapy as early as possible.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R512.62;R737.9

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