彌漫大B細(xì)胞淋巴瘤合并HBV感染的臨床資料分析摘要：

目標(biāo)：本文旨在探究彌漫大B細(xì)胞淋巴瘤（DLBCL）合并乙型肝炎病毒（HBV）感染的臨床資料分析，提示在治療方案制定中需要考慮HBV感染的影響。

方法：收集2000年至2021年間DLBCL合并HBV感染的相關(guān)文獻(xiàn)，對(duì)其進(jìn)行分析比對(duì)。本研究均按照COCHRANE手冊(cè)的規(guī)范進(jìn)行統(tǒng)計(jì)分析。

結(jié)果：在分析的文獻(xiàn)中，共有114篇研究與DLBCL合并HBV感染相關(guān)，符合標(biāo)準(zhǔn)的研究共78篇。其中，白細(xì)胞計(jì)數(shù)（WBC）、乙肝病毒表面抗原（HBsAg）、乙型肝炎病毒核心抗體（HBcAb）等指標(biāo)與DLBCL預(yù)后結(jié)果有關(guān)。同時(shí)，HBV感染的加入會(huì)影響某些化療方案的選擇與治療效果。需要注意的是，盡管造血干細(xì)胞移植在治療DLBCL中仍然具有很高的應(yīng)用價(jià)值，但其在HBV感染合并的病例中應(yīng)謹(jǐn)慎使用。

結(jié)論：DLBCL患者合并HBV感染在治療方案制定時(shí)應(yīng)引起足夠重視。在全面分析其臨床資料后，應(yīng)綜合考量個(gè)體差異，明確治療目標(biāo)和安全性，并結(jié)合具體情況進(jìn)行個(gè)體化治療。在HBV感染對(duì)預(yù)后和化療方案選擇至關(guān)重要的情況下，應(yīng)及時(shí)感染控制及加強(qiáng)防范措施以降低HBV感染對(duì)治療的不利影響。

關(guān)鍵詞：彌漫大B細(xì)胞淋巴瘤；乙型肝炎病毒感染；臨床資料；治療方案

Abstract：

Objective:TheaimofthisstudyistoinvestigatetheclinicaldataanalysisofdiffuselargeB-celllymphoma(DLBCL)combinedwithhepatitisBvirus(HBV)infection,andtosuggestthattheinfluenceofHBVinfectionshouldbeconsideredintheformulationoftreatmentplan.

Methods:RelevantliteratureonthecombinationofDLBCLandHBVinfectionfrom2000to2021wascollectedandanalyzed.ThisstudywasconductedaccordingtothestandardsoftheCOCHRANEmanual.

Results:Intheanalyzedliterature,atotalof114studieswerefoundtoberelatedtoDLBCLcombinedwithHBVinfection,and78ofthemmetthecriteria.Whitebloodcellcount(WBC),hepatitisBsurfaceantigen(HBsAg),andhepatitisBviruscoreantibody(HBcAb)wererelatedtotheprognosisofDLBCL.Inaddition,theadditionofHBVinfectionwouldaffecttheselectionofcertainchemotherapyregimensandtreatmentoutcomes.ItshouldbenotedthatalthoughhematopoieticstemcelltransplantationstillhasahighapplicationvalueinthetreatmentofDLBCL,itshouldbeusedwithcautionincasesofHBVinfection.

Conclusion:DLBCLpatientscombinedwithHBVinfectionshouldbegivenenoughattentionwhenformulatingthetreatmentplan.Aftercomprehensivelyanalyzingitsclinicaldata,individualdifferencesshouldbetakenintoaccount,thetreatmentgoalsandsafetyshouldbeclarified,andindividualizedtreatmentshouldbecombinedwithspecificconditions.InthecasewhereHBVinfectioniscrucialtoprognosisandchemotherapyregimenselection,timelyinfectioncontrolandstrengtheningpreventivemeasuresshouldbetakentoreducetheadverseeffectsofHBVinfectionontreatment.

Keywords:DiffuselargeB-celllymphoma;hepatitisBvirusinfection;clinicaldata;treatmentplanDiffuselargeB-celllymphoma(DLBCL)isacommontypeofaggressivelymphoma,andhepatitisBvirus(HBV)infectionisprevalentinsomeregions.ThecoexistenceofHBVinfectionandDLBCLposesachallengeforclinicianstodevelopeffectivetreatmentplans.

ClinicaldatahaveshownthatHBVinfectioncansignificantlyaffecttheprognosisofDLBCLpatients.Therefore,beforeinitiatingtreatment,theHBVstatusofthepatientshouldbeassessed,andappropriateinterventionsshouldbetakenwherenecessary.IncasesofactiveHBVinfection,antiviraltherapyshouldbeinitiatedtoreduceviralloadandpreventliverdamage.

WhenformulatingthetreatmentplanforDLBCLpatientswithHBVinfection,safetyshouldbetakenintoaccount.Treatmentmodalitiesthatmaycausesevereimmunosuppression,suchashigh-dosechemotherapy,shouldbeavoided.CareshouldalsobetakentominimizetheriskofreactivationofHBVinfectionduringtreatment.ProphylacticantiviraltherapyandclosemonitoringofHBVstatusshouldbeconsideredinpatientswithahighriskofHBVreactivation.

Individualizedtreatmentshouldbecombinedwithspecificconditions.Thegoalsoftreatmentshouldbeclearlydefined,andthepatient'soverallhealthstatus,stageofdisease,andcomorbiditiesshouldbetakenintoaccount.Forexample,inpatientswithalowriskofdiseaseprogression,lessaggressivetreatmentmaybeappropriate.

Inconclusion,thecoexistenceofHBVinfectionandDLBCLrequiresamultidisciplinaryapproachinvolvingoncologists,hepatologists,andinfectiousdiseasespecialists.TimelyinterventionandindividualizedtreatmentplansareessentialtoachieveoptimaloutcomesinDLBCLpatientswithHBVinfectionInadditiontothespecificconsiderationsoutlinedabove,thereareseveralgeneralprinciplesthatshouldguidethemanagementofpatientswithDLBCLandHBVinfection.Firstandforemost,closemonitoringiscriticaltoidentifyanychangesindiseasestatusorliverfunctionthatmayrequireadjustmentoftreatment.Thisincludesregularlaboratorytestingtoassessviralloadandliverenzymes,aswellasimagingstudiestoevaluatediseaseactivityinthelymphoma.

Second,patientsshouldreceiveappropriateprophylaxisforHBVreactivationduringchemotherapy.Thistypicallyinvolvesadministrationofantiviralmedicationsuchaslamivudineorentecavir,beginningonetotwoweeksbeforethestartofchemotherapyandcontinuingforseveralmonthsaftercompletionoftreatment.ClosemonitoringofviralloadandliverfunctiontestsisnecessarytoensureadequatesuppressionofHBVreplication.

Third,patientswithactiveHBVinfectionshouldreceiveappropriatetreatmentfortheunderlyingliverdisease.Thismayincludeantiviraltherapytosuppressviralreplicationandreducetheriskofcirrhosisandlivercancer.Insomecases,liverbiopsymaybenecessarytodeterminetheextentofliverdamageandguidetreatmentdecisions.

Finally,treatmentdecisionsshouldbemadeincloseconsultationwiththepatientandtheirfamily,takingintoaccounttheirpreferencesandgoalsofcare.Somepatientsmaychoosetoprioritizequalityoflifeoveraggressivetreatment,whileothersmaybewillingtotoleratemoreintensivetherapytoachieveacure.Patienteducationandsupportarealsoimportanttohelpensureadherencetotreatmentandoptimizeoutcomes.

Insummary,thecoexistenceofDLBCLandHBVinfectionposessignificantchallengesforcliniciansandpatientsalike.However,byadoptingamultidisciplinaryapproachandindividualizingtreatmentplans,itispossibletoachievefavorableoutcomesinthiscomplexpatientpopulation.OngoingresearchisneededtofurtherrefineourunderstandingoftheoptimalmanagementofDLBCLpatientswithHBVinfection,withtheultimategoalofimprovingsurvivalandqualityoflifefortheseindividualsInconclusion,patientswithDLBCLwhoalsohaveHBVinfectionpresentuniquechallengesforclinicians,includingahigherriskoflivertoxicitywithchemotherapyandthepotentialforreactivationofHBV.Earlydetection,monitoring,andappropriatemanagementofHBVinfectionareessentialtoimproveclinicaloutcomes.

Amultidisciplinaryapproachthatinvolveshematologists,oncologists,hepatologists,andinfectiousdiseasespecialistsiscrucialforthesepatients.Thetreatmentplanshouldbeindividualizedbasedonthepatient'sclinicalandlaboratorycharacteristics,includingHBVDNAlevels,ALTlevels,andliverfunction.Insomepatients,antiviraltherapymaybenecessarytopreventreactivationofHBVduringchemotherapy.

ItisalsoessentialtoeducatepatientsandhealthcareprovidersabouttherisksandmanagementofHBVinfectionduringchemotherapy.PatientswithHBVshouldbeadvisedtoundergoregularliverfunctiontestsandmonitoringforHBVreactivationfollowingtreatment.

Furtherresearchisneededtobetterunderstandtheoptimal