风湿性疾病合并乙型肝炎病毒感染12例不同免疫抑制治疗后病毒再激活的随访观察  

Follow-up of hepatitis reactivation in hepatitis B virus-infected patients with rheumatic diseases after different immunosuppressive therapy

作　　者：喻一奇 宣丹旦[2] 王佳俐[1] 邵凌云[1] 张文宏[1] 邹和建[2] 

机构地区：[1]复旦大学附属华山医院感染科,上海200040 [2]复旦大学附属华山医院风湿科,上海200040

出　　处：《中华风湿病学杂志》2015年第4期261-266,共6页Chinese Journal of Rheumatology

摘　　要：目的 观察12例风湿性疾病合并乙型肝炎病毒（HBV）感染患者接受不同免疫抑制剂治疗后对HBV再激活的影响,并评估对不同免疫抑制剂是否均有必要进行预防性抗病毒治疗.方法 对2008年1月至2012年3月确诊风湿性疾病合并HBV感染的12例患者进行长期随访.在随访期间定期检测患者肝功能、血清HBV DNA水平.结果 中位随访时间为41个月（16～48个月）.4例患者接受激素治疗,其中2例未接受预防性抗病毒治疗的患者最终出现HBV再激活,经拉米夫定或恩替卡韦抗病毒治疗后,两者的HBV复制均得到控制.5例接受DMARDs治疗和3例接受肿瘤坏死因子拮抗剂（TNFBA）治疗的患者均未接受预防性抗病毒治疗,且在随访中均未出现HBV再激活.结论 风湿性疾病合并HBV感染的患者在接受免疫抑制剂治疗后可出现HBV再激活.对需要接受激素治疗的风湿性疾病患者,推荐在治疗开始前进行预防性抗病毒治疗.而DMARDs和TNFBA对风湿性疾病合并HBV感染患者而言,仍是一种相对安全的免疫抑制剂.尽管DMARDs和TNFBA治疗后引起HBV再激活的风险较低,在治疗过程中仍必须密切监测患者的HBV DNA和肝功能水平.Objective To observe hepatitis B virus （HBV） reactivation in 12 patients with rheumatic disease undergoing immunosuppressive therapy and to evaluate whether preemptive antiviral therapy is necessary for patients receiving disease-modifying anti-rheumatic drugs （DMARDs）.Methods From January 2008 to March 2012,a total of 12 HBV-infected patients with rheumatic diseases were consecutively enrolled into this long-term follow-up study.Liver function and serum levels of HBV DNA were tested during the follow-up.Results The medium duration of follow-up was 41 months （range 16-48）.Four patients received steroid treatment,and among them two patients without pre-emptive antiviral therapy developed HBV reactivation.After administr-ation of LAM or ETV,HBV replication was controlled in both patients.Five patients were treated with disease-modifying anti-rheumatic drugs and the other three patients received tumor necrosis factor-alpha-blocking agents.None of these patients received pre-emptive antiviral therapy.HBV reactivation did not occur in any of them.Conclusion HBV reactivation does occur in HBV-infected patients with rheumatoid diseases after immunosuppressive therapy.Pre-emptive antiviral therapy should be administered in patients who are receiving steroid therapy for rheumatic diseases.In contrast,DMARDs and TNFBA are relatively safe for HBV-infected patients with rheumatic diseases.Close monitoring of HBV DNA and ALT levels is necessary to the mana-gement of HBV reactivation.

关 键 词：乙型肝炎病毒 风湿性疾病 糖皮质激素类 抗风湿药 肿瘤坏死因子-Α拮抗剂 

分 类 号：R593.21[医药卫生—内科学] R512.62[医药卫生—临床医学]