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題名 | 化療病患的急性肝炎發生率及病毒性肝炎檢測率:單一醫學中心之經驗=Prevalence of Acute Hepatitis and Detection Rate of Viral Hepatitis in Cancer Patients Receiving Chemotherapy: A Single Institution Experience |
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作者 | 陳苓萍; 余憲忠; 許秉毅; 顏伶容; 林儷如; 林世哲; 余明生; | 書刊名 | 內科學誌 |
卷期 | 21:5 2010.10[民99.10] |
頁次 | 頁350-358 |
分類號 | 415.5332 |
關鍵詞 | 化學治療; B型肝炎; C型肝炎; 急性肝炎; 發生率; 檢測率; Chemotherapy; Hepatitis B; Hepatitis C; Acute hepatitis; Incidence; Detection rate; |
語文 | 中文(Chinese) |
中文摘要 | 接受化療或免疫抑制治療可能造成病毒性肝炎的復發,因愈來愈多證據證實B型肝炎 復發的嚴重性,針對接受化療或免疫抑制治療的慢性B肝患者,健保自2009年10月起給付 預防性抗病毒用藥。此研究針對本院2009年新診斷的乳癌、大腸直腸癌及肺癌個案,及 2008年至2009年間的淋巴瘤新個案,回溯性分析病患的急性肝炎發生率、病毒性肝炎檢測 率及預後。收案共913位病患,包含142位淋巴瘤、289位乳癌、289位大腸直腸癌及193位肺 癌病患。其中,65.5%淋巴瘤病患(n=93)、60.2%乳癌病患(n=174)、52.2%大腸直腸癌病患 (n=151)及96.9%肺癌病患(n=187)曾接受化療。急性肝炎定義為符合以下任一條件:alanine aminotransferase (ALT)由化療前正常上升至超過100 U/L、或化療前不正常的ALT治療後上升 至基準值3倍以上,或是total bilirubin大於或等於2.0 mg/dL。化療病患併發急性肝炎比例分 別為:淋巴瘤26.9%、乳癌6.3%、大腸直腸癌13.9%及肺癌16.1%(p 值<0.001)。而在整體 存活期的多變項分析中,併發急性肝炎為顯著偏差的預後因子(危險比1.852;95%信賴區間 1.185-2.894;p 值為0.007)。同時,病毒性肝炎檢測比率在淋巴瘤、乳癌、大腸直腸癌及肺 癌則各為91.4%, 9.2%, 21.2%及18.2%(p 值<0.001),而HBsAg陽性經多變項分析確定為併 發急性肝炎的獨立危險因子(p 值為0.027)。乳癌、大腸直腸癌及肺癌等固態腫瘤化療後併 發急性肝炎的比例明顯較淋巴瘤低,因此過去固態腫瘤病患檢測病毒性肝炎的比率也顯著偏 低,而在逐漸累積的臨床試驗證據支持及健保給付抗病毒藥物的前提下,篩檢化療病患的病 毒肝炎指標已屬必備項目,用以保護病患權益及避免醫療糾紛。 |
英文摘要 | Hepatitis B reactivation is a serious and well-documented complication in hepatitis B carriers receiving chemotherapy. Because of high prevalence of hepatitis B in Taiwan region, our National Health Insurance has commenced subsidizing prophylactic anti-viral drugs in these chronic hepatitis B patients since October 2009. In order to clarify the impact of acute hepatitis flare on our patients, we retrospectively reviewed medical records of patients newly diagnosed with breast, colorectal and lung cancer in 2009 and fresh lymphoma patients diagnosed between 2008 and 2009 in our hospital. The incidence of acute hepatitis, screening rate of viral hepatitis marker and outcomes of these patients were analyzed. This study enrolled 913 patients, who included 142 lymphoma patients, 289 breast cancer patients, 289 colorectal cancer patients, and 193 lung cancer patients. There were 65.5% of lymphoma patients (n=93), 60.2% of breast cancer patients (n=174), 52.2% of colorectal cancer patients (n=151), and 96.9% of lung cancer patients (n=187), who received chemotherapy. Acute hepatitis was defined as elevation of alanine aminotransferase (ALT) from a normal baseline till more than 100 mg/dL, a 3-fold elevation from an abnormal baseline, or an elevated total bilirubin level to 2.0mg/dL or more. Acute hepatitis was detected in 26.9%, 6.3%, 13.9%, and 16.1% of lymphoma, breast cancer, colorectal cancer and lung cancer patients (p<0.001); in addition, the screening rates of viral hepatitis markers for hepatitis B or hepatitis C were 91.4%, 9.2%, 21.2% and 18.2% respectively (p<0.001). HBsAg-positive significantly increased the risk of acute hepatitis (p=0.027). Furthermore, acute hepatitis proved to be an independent poor prognostic factors in the multivariate analysis of overall survival (Hazard ratio 1.852; 95% of CI 1.185-2.894; p=0.007). Percentage of acute hepatitis was significantly lower in solid tumor and the screening rate of viral hepatitis markers was also lower, hence the possibility of viral hepatitis reactivation had probably been underestimated in the past. Based on the strong evidence from clinical trials and with the sponsor of the National Health Insurance system, routine screening of viral hepatitis markers in patients undergoing chemotherapy is strongly recommended for prevention of hepatitis reactivation and to avoid possible legal problems. |
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