CAJ | 학술논문

目的了解临床医生在RA免疫干预治疗前乙型肝炎病毒(HBV)筛查及HBV表面抗原(HBsAg)阳性的RA患者临床管理现状.方法采用改良ACR问卷对有RA诊治经验的150名临床医生进行调查,内容包括医生一般情况和10个多项选择题.逐步向前法多元回归分析用于筛选影响因素,再行受试者工作特征曲线分析及曲线下面积证实该影响因素的决定作用.结果实际回收有效问卷132份.RA免疫干预治疗前,门诊患者常规HBV筛查率显著低于住院患者(68.7％和94.6％,x2=31.5,P＜0.01).仅23.7％(31/131)的医生认为所有HBsAg阳性的RA患者均需抗病毒治疗.113位医生有抗病毒治疗经验,仅30.1％(34/113)、23.9％(27/113)的医生分别选择恩替卡韦、阿德福韦酯作为抗病毒药物;59.3％(67/113)的医生选择在RA治疗开始前或同时开始抗病毒,40.7％(46/113)选择在HBV再激活发生后;仅20.4％(23/113)的医生选择将抗病毒治疗持续至激素及DMARDs停药后.HBsAg阳性患者免疫干预治疗期间,11.4％(15/132)的医生未定期监测转氨酶,30.3％(40/132)未定期监测HBV DNA.结论门诊RA患者免疫干预治疗前常规HBV筛查率低,对合并HBV感染患者抗病毒治疗的指证、药物选择、开始时机、疗程及治疗过程中的监测认识不足,今后应加强相关知识在医生中的普及并加强与肝病专科的合作.
목적 료해림상의생재RA면역간예치료전을형간염병독(HBV)사사급HBV표면항원(HBsAg)양성적RA환자림상관리현상.방법 채용개량ACR문권대유RA진치경험적150명림상의생진행조사,내용포괄의생일반정황화10개다항선택제.축보향전법다원회귀분석용우사선영향인소,재행수시자공작특정곡선분석급곡선하면적증실해영향인소적결정작용.결과 실제회수유효문권132빈.RA면역간예치료전,문진환자상규HBV사사솔현저저우주원환자(68.7％화94.6％,x2=31.5,P＜0.01).부23.7％(31/131)적의생인위소유HBsAg양성적RA환자균수항병독치료.113위의생유항병독치료경험,부30.1％(34/113)、23.9％(27/113)적의생분별선택은체잡위、아덕복위지작위항병독약물;59.3％(67/113)적의생선택재RA치료개시전혹동시개시항병독,40.7％(46/113)선택재HBV재격활발생후;부20.4％(23/113)적의생선택장항병독치료지속지격소급DMARDs정약후.HBsAg양성환자면역간예치료기간,11.4％(15/132)적의생미정기감측전안매,30.3％(40/132)미정기감측HBV DNA.결론 문진RA환자면역간예치료전상규HBV사사솔저,대합병HBV감염환자항병독치료적지증、약물선택、개시시궤、료정급치료과정중적감측인식불족,금후응가강상관지식재의생중적보급병가강여간병전과적합작.
Objective To investigate doctor's screening practice for hepatitis B virus (HBV) infection before immunosuppressive therapy for rheumatoid arthritis (RA) patients and clinical management of RA patients with positive surface antigen of HBV (HBsAg).Methods One hundred fifty doctors who treated RA patients in daily clinic were survied with a modified American College of Rheumatology (ACR) questionnaire which was composed of demographic data and 10 multiple-choice questions.Step-forward logistic regression analysis was performed to find out the influencing factors,then receiver operator characteristic curve analysis and area under the curve were performed to confirm the influencing factors.Results One hundred and thirtytwo effective questionnaires were collected.Before immunosuppressive therapy,HBV screening rate in outpatients with RA was significandy lower than that in hospitalized patients (68.7％ vs 94.6％,x2=31.5,P＜0.01).Only 23.7％(31/131) of doctors considered antiviral treatment for all RA patients with positive HBsAg.One hundred and thirteen doctors had clinical experience of antiviral treatment,but only 30.1％(34/113) and 23.9％ (27/113) of these doctors chose entecavir or adefovir as the antiviral drug respectively,59.3％ (67/113) prescribed antiviral drug before or together with immunosuppressive therapy compared with 40.7％(46/113) after HBV reactivation.Only 20.4％(23/113) of doctors would sustain antiviral treatment until the termination of steroid or disease modifying antirheumatic drugs (DMARDs).During immunosuppressive therapy for HBsAg(+) RA patients,11.4％(15/132) and 30.3％(40/132) of doctors reported no regular monitoring of aminotransferase or HBV DNA respectively.Conclusion Our survey shows that HBV screening rate in outpatients with RA is low and low awareness of antiviral treatment for all RA patients with positive HBsAg,and lack of awareness of indication,choosing of antiviral drugs,initiation,monitoring and duration of antiviral treatment during immunosuppressive therapy.Further medical education on the associated information and importance to collaborate with hepatologists should be emphasized.