风湿病免疫抑制剂治疗致乙肝病毒再激活的临床观察  

Clinical observation of Hepatitis B virus(HBV) reactivation caused by immunosuppressive therapy of rheumatic disease

作　　者：高利霞[1] 观美华[1] 王飞[1] 马永华[1] 钟彩玲[1] 

机构地区：[1]广东省湛江中心人民医院血液风湿科,广东湛江524037

出　　处：《中国现代医生》2014年第3期142-145,共4页China Modern Doctor

摘　　要：目的探讨风湿病患者使用免疫抑制剂过程中乙肝病毒再激活的发生情况及抗病毒治疗的效果。方法 26例风湿病患者被分为三组,HBV复制组(HBsAg阳性+HBV-DNA阳性):免疫抑制剂治疗前1周加用抗病毒药拉米夫定100 mg/d;HBV无复制组(HBsAg阳性+HBV-DNA阴性):免疫抑制剂治疗前先不加抗病毒药物,随访中如出现HBV-DNA转阳则加用抗病毒药拉米夫定100 mg/d治疗,既往暴露组(HBsAg阴性+抗HBc阳性):随访中出现HBsAg或HBV-DNA转阳加用抗病毒治疗。结果 HBV复制组11/13出现HBV-DNA转阴;HBV无复制组4/11出现HBV-DNA转阳;既往暴露组1/2出现HBV-DNA转阳,这5例发生再激活的患者予拉米夫定治疗后HBV-DNA均转阴。结论合并乙型病毒性肝炎的风湿病患者使用免疫抑制剂治疗可能会导致HBV再激活,一旦出现再激活则需及时采取抗病毒治疗。对于HBsAg阳性同时HBV-DNA阴性的风湿病患者,免疫抑制剂治疗前可能需要进行预防性抗病毒治疗。不能忽视既往暴露的患者,需密切监测乙肝两对半及HBV-DNA的变化。Objective To investigate the Hepatitis B Virus （HBV） reactivation in the process of immunosuppressive therapy of rheumatic disease, and to evaluate the effect of anti-HBV therapy. Methods All the research object is divided into three groups： in HBV active group patients received 100mg of lamivudine once daily one week before they were treated with immunosuppressive;in HBV inactive group patients were treated with immunosuppressive but without antiviral drug at first,the patients whose HBV-DNA become positive during the treatment above would received lO0mg of lamivudine once daily one week;in always exposure group patients would received 100mg of lamivudine once daily one week,if HBsAg or HBV-DNA become positive during the treatment. Results In HBV active group HBV-DNA turned to negative in 11 of 13 patients and decreased in other 2 patients;in HBV inactive group HBV-DNA turned to positive in 4 of 14 patients; in always exposure group HBV-DNA turned to positive in 1 of 2 patients;the five patients with HBV reactivation HBV-DNA turned to negative after were treated with lamivudine. Conclusion rheumatism patients with HBV use immunosuppressive therapy may result in HBV reactivation.It is will be take antiviral treatment timely once appear.It may be needed to antiviral treatment preventively to rheumatism patients with positive for HBsAg and HBV-DNA negative before immunosuppressive therapy. We can not ignored always exposed patients,should be monitoring the second liver two half-and- half and HBV-DNA closely.

关 键 词：风湿病 免疫抑制 乙肝病毒 再激活 

分 类 号：R512.62[医药卫生—内科学]