英夫利西单抗在HBV感染炎症性肠病患者中使用的安全性  

Safety of Infliximab in Inflammatory Bowel Disease Patients With HBV Infection

作　　者：戴张晗[1] 王天蓉[1] 郑青[1] 冉志华[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化内科,200127

出　　处：《胃肠病学》2017年第10期582-587,共6页Chinese Journal of Gastroenterology

摘　　要：背景:免疫抑制治疗过程中发生乙型肝炎病毒(HBV)复燃危害重大。合并HVB感染的炎症性肠病(IBD)患者在生物制剂治疗过程中可能发生HBV复燃。目的:研究我国合并HBV感染IBD患者在使用英夫利西单抗(IFX)治疗时的HBV复燃情况。方法:回顾性连续纳入2014年3月—2017年3月在上海仁济医院诊断为IBD、HBc Ab阳性并接受IFX治疗的住院患者,采集相关临床资料和随访信息,观察病毒复制和肝功能变化。结果:194例接受IFX治疗的IBD患者中28例合并HBV现症或既往感染,总体感染率为14.4%,现症感染率为4.6%。28例患者平均IFX疗程(6.96±3.47)次,平均随访时间(15.32±10.47)个月。15例(53.6%)患者接受预防性抗病毒治疗,1例使用拉米夫定,14例使用恩替卡韦。10例(35.7%)患者采用IFX与免疫抑制剂协同治疗,其中1例(10.0%)HBV现症感染患者(HBs Ag阳性,HBV-DNA阴性)治疗过程中出现HBV复燃。该例患者采用拉米夫定预防性抗病毒治疗,将抗病毒药物更换为恩替卡韦后HBV-DNA降至检测下限。结论:使用IFX治疗的IBD患者应筛查HBV感染状态。合并HBV感染者在IFX与免疫抑制剂协同治疗的情况下可选用低耐药率的抗病毒药物行预防性抗病毒治疗,从而降低病毒复燃率。Background： Reactivation of hepatitis B virus（ HBV） in the context of immunosuppressive therapy is serious.Biological agents are known having the effect to increase the risk of HBV reactivation in patients with inflammatory bowel disease（ IBD） who are seropositive for HBs Ag and/or HBc Ab. Aims： To study the HBV reactivation in IBD patients with HBV infection who are treated with infliximab（ IFX） in China. Methods： A retrospective study was conducted between March 2014 and March 2017 in Shanghai Renji Hospital. Consecutive IBD patients who were seropositive for HBc Ab and treated with IFX were enrolled. The clinical and follow-up data were analyzed and the changes in viral replication and liver function were recorded. Results： Of the 194 IBD patients treated with IFX,28 had active or prior HBV infection. The overall prevalence of HBV infection was 14. 4%,and that of active infection was 4. 6%. The mean number of IFX treatment course was 6. 96 ± 3. 47,and the mean follow-up period was（ 15. 32 ± 10. 47） months. Fifteen patients（ 53. 6%） received prophylactic antiviral treatment,one with lamivudine and 14 with entecavir. Ten patients（ 35. 7%）received synergistic treatment with immunosuppressants,of which,one（ 10. 0%） with active HVB infection（ HBs Ag positive and HBV-DNA negative） suffered HBV reactivation. In this reactivation case,lamivudine antiviral prophylaxis was used initially and the reactivation was resolved when entecavir was used instead of lamivudine. Conclusions： IBD patients receiving IFX treatment should be screened for HBV infection. In patients who are seropositive for HBs Ag and/or HBc Ab,prophylactic antiviral agents with low resistance rate is recommended for preventing HBV reactivation when IFX and immunosuppressants are synergistically used.

关 键 词：乙型肝炎病毒 炎症性肠病 英夫利西单抗 免疫抑制剂 抗病毒治疗 安全 

分 类 号：R512.62[医药卫生—内科学] R574[医药卫生—临床医学]