CAJ | 학술논문

目的了解系统性红斑狼疮(SLE)合并乙型肝炎病毒(HBV)感染患者临床特点.方法回顾性分析2003年2月至2011年6月在北京协和医院住院的40例合并HBV感染的SLE患者临床资料,并与性别、发病年龄相匹配的60例无HBV感染的SLE患者比较.统计学方法采用t检验和x2检验.结果 40例合并HBV感染者中男性4例,女性36例,平均年龄(32±13)岁；其中23例患者表现为慢性乙型肝炎,5例为HBV携带状态,12例为既往无症状感染.21例慢性乙型肝炎患者肝功能轻度异常主要为丙氨酸转氨酶升高,2例严重肝功能异常.临床表现合并HBV感染组和对照组比较,发热、肝脏受累、肾脏受累、血小板减少、巨细胞病毒感染更常见.肾病变主要为Ⅳ型或Ⅴ型狼疮肾炎,2例合并HBV相关性肾炎.血清乙型肝炎病毒表面抗原(HBsAg)阳性的SLE患者在接受免疫抑制剂治疗时同时使用拉米夫定抗病毒治疗.患者出院好转率为98％ (39/40),1例预后不佳者有严重肝脏病变.结论应重视SLE合并HBV感染患者临床特点:SLE合并HBV感染患者发热、肝脏受累、肾脏受累、血小板减少、巨细胞病毒感染者增多,可合并HBV相关性肾炎；肝脏病变严重者预后差；血清HBsAg阳性的SLE患者在接受免疫抑制剂治疗时应同时使用抗HBV药治疗.
목적 료해계통성홍반랑창(SLE)합병을형간염병독(HBV)감염환자림상특점.방법 회고성분석2003년2월지2011년6월재북경협화의원주원적40례합병HBV감염적SLE환자림상자료,병여성별、발병년령상필배적60례무HBV감염적SLE환자비교.통계학방법채용t검험화x2검험.결과 40례합병HBV감염자중남성4례,녀성36례,평균년령(32±13)세；기중23례환자표현위만성을형간염,5례위HBV휴대상태,12례위기왕무증상감염.21례만성을형간염환자간공능경도이상주요위병안산전안매승고,2례엄중간공능이상.림상표현합병HBV감염조화대조조비교,발열、간장수루、신장수루、혈소판감소、거세포병독감염경상견.신병변주요위Ⅳ형혹Ⅴ형랑창신염,2례합병HBV상관성신염.혈청을형간염병독표면항원(HBsAg)양성적SLE환자재접수면역억제제치료시동시사용랍미부정항병독치료.환자출원호전솔위98％ (39/40),1례예후불가자유엄중간장병변.결론 응중시SLE합병HBV감염환자림상특점:SLE합병HBV감염환자발열、간장수루、신장수루、혈소판감소、거세포병독감염자증다,가합병HBV상관성신염；간장병변엄중자예후차；혈청HBsAg양성적SLE환자재접수면역억제제치료시응동시사용항HBV약치료.
Objective To investigate the clinical features of patients with systemic lupus erythematosus (SLE) complicating with hepatitis B virus (HBV) infection.Methods The medical records of 40 inpatients with SLE complicating with HBV infection and 60 SLE inpatients without HBV infection were analyzed retrospectively.Chi-square test and t test were used for statistical analysis.Results Forty patients with SLE complicating with HBV infection were included,including 4 men and 36 women,with the mean age of (32±13) yr.Twenty-three patients suffered from chronic HBV hepatitis,5 patients were serological HBsAg carriers,12 patients with HBV "occult infection".Twenty-one patients had mild liver dysfunction,presented mainly as increased ALT,2 patients presented with severe liver function abnormality.The main types of lupus rlephritis were Class Ⅳ and Class Ⅴ,2 patients complicating with HBV-associated glomerulonephritis.Compared with the control group,patients with SLE complicating with HBV infection had a significantly higher prevalence of fever,liver involvement,renal lesion,thrombocytopenia and cytomegalovirus infection respectively.One patient with severe liver abnormality had poor prognosis.Conclusion More attention should be paid to the clinical features of SLE complicating with HBV infection.Patients with SLE complicating with HBV infection have a significantly higher prevalence of fever,liver involvement,renal lesion,thrombocytopenia and cytomegalovirus infection respectively.Patients with SLE complicating with HBV infection may suffer from HBV-associated glomerulonephritis.Severe liver abnormality predicts poor prognosis.Anti-HBV drugs should be prescribed for SLE patients with serological positive HBsAg while immunosuppressive agents are used.