Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Hematolojik Maligniteli Hastalarda Hepatit B Virüs Serolojileri, Antiviral Profilaksi ve Reaktivasyon Hepatit Oranlarının Değerlendirilmesi
Evaluation of Hepatitis B Virus Serology, Antiviral Use and Reactivation Hepatitis in Hematologic Malignancy Patients
Nagehan Didem SARIa, Ayşe İNCİa, Mehmet Hilmi DOĞUb, Gülşen YÖRÜKa
aİstanbul Eğitim Araştırma Hastanesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, İstanbul, TÜRKİYE
bİstanbul Eğitim Araştırma Hastanesi, Hematoloji Kliniği, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2020;40(1):74-8
doi: 10.5336/medsci.2019-71432
Article Language: TR
Full Text
ÖZET
 Amaç: Hepatit B virüs (HBV) enfeksiyonu, aşı uygulamaları ve uygulanan tedavilere rağmen global sağlık sorunu olmaya devam etmektedir. HBV enfeksiyonunun klinik seyrini konağın immünitesi belirlemektedir. Geçmişte HBV ile karşılaşmış olmak ömür boyu viral genomun konak hücresinde kalıcılığına neden olur. İmmün sistemi baskılayan bir hastalık geliştiğinde HBV üzerindeki kontrol kalkabilir ve hastalar reaktivasyon riskiyle karşılaşabilirler. Bu çalışmada amacımız, hematolojik hastalığı nedeni ile kemoterapi planlanan hastalarda HBV serolojileri, antiviral kullanımı ve reaktivasyon oranlarının değerlendirilmesidir. Gereç ve Yöntemler: Ocak 2013-Aralık 2018 tarihleri arasında, SBÜ İstanbul Eğitim ve Araştırma Hastanesi Hematoloji Polikliniğine başvuran tüm hastalar 'Hastane Bilgi Yönetim Sistemi' kullanılarak retrospektif olarak tarandı. HBV enfeksiyonunun serolojik göstergesi olarak HBsAg, anti-HBs ve anti-HBc immünglobulin G (Ig G) tetkiklerinden birinin sonuçları olan 1.389 hasta değerlendirildi. Bulgular: Hastalardan hepatit serolojisine ait, anti-HBs, HBsAg ve anti-HBc IgG tetkiklerinin tamamı istenmiş olan 791 hasta çalışmaya alındı. Bu hastaların %4,93 (39/791)'ünde HBsAg pozitif, %33,63 (266/791)'ünde anti-HBs pozitif ve %16,06 (127/791)'sında izole anti-HBc IgG pozitif tespit edildi. Çalışmamızda, 39 HBsAg pozitif ve 127 anti-HBc IgG pozitif olan toplam 166 hastadan 145 (%87,35)'ine antiviral profilaksi verilmişti. HBV DNA'sı profilaksi altında pozitifleşen 9 hasta mevcuttu. Bu hastaların tedavi değişikliği sonrasında 6. ay da HBV DNA'ları negatifleşti. Sonuç: Sonuç olarak, çalışmamızda, HBV serolojik testlerin doğru tarama oranının literatürde önerilenden daha düşük olduğu belirlenmiştir. Kemoterapi planlanmış olan hematolojik maligniteli hastalarda reaktivasyon, kemoterapiye ara verme, karaciğer yetmezliği gibi risk faktörleri düşünüldüğünde; bu hastaların HBV enfeksiyonu açısından önerilen şekilde taranmasının gerektiği ve konuyla ilgili daha fazla hasta sayısını içeren prospektif çalışmaların yapılarak farkındalığın artırılmasının gerektiği düşünülmektedir.

Anahtar Kelimeler: Hepatit B yüzey antijeni; antineoplastik ajanlar
ABSTRACT
 Objective: Hepatitis B virus (HBV) infection continues to be a global health problem. The clinical course of HBV infection is determined by the host immunity. When an immuno- suppressive disease develops, control over HBV may disappear and patients may experience reactivation risk. In this study, we aimed to evaluate HBV serology, antiviral use and reactivation rates in patients undergoing chemotherapy for hematological disease. Material and Methods: All patients who applied to the Hematology Outpatient Clinic of Univesity of Health Sciences Turkey İstanbul Education Research Hospital between January 2013-December 2018 were screened, 1.389 patients with the results of all HBsAg, anti-HBs and anti-HBc immunoglobulin G (IgG) serologic markers. Results: In this study 791 patients with hepatitis serology tested for anti-HBs, HBsAg and anti-HBc IgG tests were included. HBsAg positive 4.93% (39/791), anti-HBs positive 33.63% (266/791) and 16.06% (127/791) isolated anti-HBc IgG positive were detected in these patients. Anviral prophylaxis was given to 145 (87.35%) out of 166 patients with 127 anti-HBc IgG positive and 39 HBsAg positive in our study. There were nine patients with lamivudine prophylaxis and reactivation. HBV DNA was negative at 6 months after treatment change. Conclusion: In conclusion, in our study, the accurate screening rate of HBV serological tests was found to be lower than recommended in the literature. Considering the risk factors such as reactivation, interruption of chemotherapy and hepatic failure in patients with hematologic malignancy planned for chemotherapy; we suggest that these patients should be screened for HBV infection as recommended and that awareness should be increased by conducting prospective studies involving more patients.

Keywords: Hepatitis B surface antigen; antineoplastic agents
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