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：alanineaminotransferase (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。

Hepatitis B reactivation is a serious and well-documented complication in hepatitis B carriers receivingchemotherapy. Because of high prevalence of hepatitis B in Taiwan region, our National Health Insurance hascommenced subsidizing prophylactic anti-viral drugs in these chronic hepatitis B patients since October 2009. Inorder to clarify the impact of acute hepatitis flare on our patients, we retrospectively reviewed medical records ofpatients newly diagnosed with breast, colorectal and lung cancer in 2009 and fresh lymphoma patients diagnosedbetween 2008 and 2009 in our hospital. The incidence of acute hepatitis, screening rate of viral hepatitis markerand outcomes of these patients were analyzed. This study enrolled 913 patients, who included 142 lymphomapatients, 289 breast cancer patients, 289 colorectal cancer patients, and 193 lung cancer patients. There were65.5% 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 aselevation of alanine aminotransferase (ALT) from a normal baseline till more than 100 mg/dL, a 3-fold elevationfrom an abnormal baseline, or an elevated total bilirubin level to 2.0mg/dL or more. Acute hepatitis was detected in26.9%, 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 ofoverall survival (Hazard ratio 1.852; 95% of CI 1.185-2.894; p=0.007). Percentage of acute hepatitis was significantlylower in solid tumor and the screening rate of viral hepatitis markers was also lower, hence the possibility of viralhepatitis reactivation had probably been underestimated in the past. Based on the strong evidence from clinical trialsand with the sponsor of the National Health Insurance system, routine screening of viral hepatitis markers in patientsundergoing chemotherapy is strongly recommended for prevention of hepatitis reactivation and to avoid possiblelegal problems.