CAJ | 학술논문

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.
목적 관찰12례풍습성질병합병을형간염병독(HBV)감염환자접수불동면역억제제치료후대HBV재격활적영향,병평고대불동면역억제제시부균유필요진행예방성항병독치료.방법 대2008년1월지2012년3월학진풍습성질병합병HBV감염적12례환자진행장기수방.재수방기간정기검측환자간공능、혈청HBV DNA수평.결과 중위수방시간위41개월(16～48개월).4례환자접수격소치료,기중2례미접수예방성항병독치료적환자최종출현HBV재격활,경랍미부정혹은체잡위항병독치료후,량자적HBV복제균득도공제.5례접수DMARDs치료화3례접수종류배사인자길항제(TNFBA)치료적환자균미접수예방성항병독치료,차재수방중균미출현HBV재격활.결론 풍습성질병합병HBV감염적환자재접수면역억제제치료후가출현HBV재격활.대수요접수격소치료적풍습성질병환자,추천재치료개시전진행예방성항병독치료.이DMARDs화TNFBA대풍습성질병합병HBV감염환자이언,잉시일충상대안전적면역억제제.진관DMARDs화TNFBA치료후인기HBV재격활적풍험교저,재치료과정중잉필수밀절감측환자적HBV DNA화간공능수평.
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.