Hepatitis B virus (HBV) infection is a major public health problem worldwide. More than 2 billion people have been exposed to HBV, and about 257 million individuals are chronic carriers of HBV. HBV reactivation has been increasingly reported in HBV carriers who have undergone immunosuppression or chemotherapy, resulting in mortality. Treatment of hypothalamic/pituitary tumors in HBV carriers requires extensive care to avoid HBV reactivation as steroid therapy is required after surgery for hypothalamic/pituitary tumors. This retrospective review identified 5 patients, who were HBV carriers positive for hepatitis B surface antigen among 1352 patients with surgically treated hypothalamic/pituitary tumor in Kohnan Hospital between February 2007 and April 2017. Transsphenoidal surgery was performed with particular attention to prevent damage to the pituitary gland, with delicate manipulation to minimize postoperative steroid coverage. All patients received nucleot(s)ide analogue to control HBV-DNA levels before the surgery. As a result, all patients had a good clinical course. Blood examinations found a transient increase of liver enzymes and HBV-DNA levels in all patients, which started to decrease within 2 weeks after surgery. No specific treatment other than nucleot(s)ide analogues was needed to maintain liver function, and all patients returned to their previous activities including reinstatement. Initiation of nucleot(s)ide analogues administration prior to the surgery for hypothalamic/pituitary tumors can be an effective strategy for preventing reactivation in HBV carriers. Appropriate screening of the patient’s HBV phase, optimal timing of nucleot(s)ide analogues -administration, and administration period of nucleot(s)ide analogues need to be established.

中文翻译：

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下丘脑和垂体肿瘤神经外科治疗后患者潜伏性乙型肝炎的病例报告。


乙型肝炎病毒（HBV）感染是全球主要的公共卫生问题。超过20亿人接触过乙肝病毒，约2.57亿人是乙肝病毒的慢性携带者。越来越多的报道称，接受免疫抑制或化疗的乙型肝炎病毒携带者出现乙型肝炎病毒再激活，导致死亡。乙型肝炎病毒携带者的下丘脑/垂体肿瘤的治疗需要广泛的护理，以避免乙型肝炎病毒再激活，因为下丘脑/垂体肿瘤手术后需要类固醇治疗。这项回顾性研究在 2007 年 2 月至 2017 年 4 月期间在 Kohnan 医院接受手术治疗的 1352 例下丘脑/垂体肿瘤患者中，确定了 5 例乙型肝炎表面抗原阳性的 HBV 携带者。进行经蝶手术时特别注意防止垂体损伤腺体，通过精细的操作以尽量减少术后类固醇的覆盖。所有患者在手术前均接受核苷酸类似物控制 HBV-DNA 水平。结果，所有患者都有良好的临床病程。血液检查发现所有患者的肝酶和 HBV-DNA 水平短暂升高，并在术后 2 周内开始下降。除了核苷酸类似物之外，不需要其他特殊治疗来维持肝功能，所有患者都恢复了之前的活动，包括恢复。在下丘脑/垂体肿瘤手术前开始给予核苷酸类似物可能是预防乙型肝炎病毒携带者再激活的有效策略。需要确定患者的 HBV 阶段的适当筛查、核苷酸类似物给药的最佳时机以及核苷酸类似物的给药周期。