CAJ | 학술논문

目的观察炎性关节病患者使用TNFα拮抗剂治疗前后的乙型肝炎患病情况及HBV活动情况.方法收集2013年4月至2014年2月北京协和医院风湿科门诊就诊的需使用TNFα拮抗剂治疗的炎性关节病患者,排除其中属于活动性乙型肝炎或慢性HBsAg携带者中HBV DNA阳性的患者,观察基线、第3个月、第6个月转氨酶、HBV标志物、乙型肝炎病毒核酸(HBV DNA)的情况.结果完成本研究观察156例,HBsAg携带者11例(7.05％),其中非活动性HBsAg携带者7例,慢性HBsAg携带者4例.1例HBV DNA阴性慢性乙型肝炎携带的类风湿关节炎患者,英夫利西单抗治疗3个月后出现ALT＞ 100 IU/L,HBV DNA 1 ×105拷贝/ml,加用拉米夫定后ALT逐渐下降,HBV DNA逐渐下降至＜1 ×103拷贝,在第6个月的随访中转氨酶正常,HBV DNA阴性,持续英夫利西单抗和拉米夫定治疗,随访6个月未再发现转氨酶损害和HBV DNA升高.余155例患者未发现转氨酶、HBV标志物和病毒DNA再复制的变化.结论 HBV携带者在使用TNFα拮抗剂过程中,需全程监控病毒复制情况,病毒的激活与TNFα拮抗剂的疗程剂量无关.病毒复制激活者需全程抗病毒治疗.
목적 관찰염성관절병환자사용TNFα길항제치료전후적을형간염환병정황급HBV활동정황.방법 수집2013년4월지2014년2월북경협화의원풍습과문진취진적수사용TNFα길항제치료적염성관절병환자,배제기중속우활동성을형간염혹만성HBsAg휴대자중HBV DNA양성적환자,관찰기선、제3개월、제6개월전안매、HBV표지물、을형간염병독핵산(HBV DNA)적정황.결과 완성본연구관찰156례,HBsAg휴대자11례(7.05％),기중비활동성HBsAg휴대자7례,만성HBsAg휴대자4례.1례HBV DNA음성만성을형간염휴대적류풍습관절염환자,영부리서단항치료3개월후출현ALT＞ 100 IU/L,HBV DNA 1 ×105고패/ml,가용랍미부정후ALT축점하강,HBV DNA축점하강지＜1 ×103고패,재제6개월적수방중전안매정상,HBV DNA음성,지속영부리서단항화랍미부정치료,수방6개월미재발현전안매손해화HBV DNA승고.여155례환자미발현전안매、HBV표지물화병독DNA재복제적변화.결론 HBV휴대자재사용TNFα길항제과정중,수전정감공병독복제정황,병독적격활여TNFα길항제적료정제량무관.병독복제격활자수전정항병독치료.
Objective To investigate the prevalence of HBV infection and the risk of hepatitis B virus (HBV) reactivation in patients with inflammatory arthritis receiving tumour hecrosis factor alpha (TNFα) inhibitors.Methods The liver function,serology of HBV and viral loads (HBV DNA) were tested before using TNFα inhibitors,at 3 months and 6 months.Patients with chronic hepatitis B (CHB) infection (HBV DNA ＞ 1 × 103copies/ml) were eliminated.Results A total of 162 patients were investigated including 156 patients who finished the study.Eleven (7.05％) patients were HBsAg-positive.Two patients with HBV DNA ＞ 1 × 103copies/ml were eliminated before starting anti-TNFα therapy.Among HBsAgpositive patients,HBV reactivation was documented in only one of the 11 patients.This patient with rheumatoid arthritis developed elevation of glutamic-pyruvic transaminase (ALT) and HBV DNA copies three months after infliximab therapy.Therefore lamivudine was given for three months,which translated into the fall of ALT and HBV DNA copies back to normal level.After follow-up for six months,the virology and serology remained stable.In contrast,none of the other 155 patients had demonstrated evidence of HBV infection or HBV reactivation.Conclusion The kinetics of HBV viral loads should be carefully monitored in patients with inflammatory arthritis and HBsAg-positive during anti-TNFα therapy.HBV reactivation should be treated with antiviral medicine through out the period of anti-TNFα therapy.