论文部分内容阅读
目的探讨乙肝表面抗原(surface antigen of hepatitis B,HBs Ag)阳性的类风湿性关节炎(rheumatoid arthritis,RA)患者使用口服改善病情抗风湿药物(disease modifying anti-rheumatic drugs,DMARDs)治疗及预防性抗乙肝病毒(hepatitis B virus,HBV)治疗对HBV再激活的影响。方法选择2012年1月—2016年1月17例HBs Ag阳性RA患者进行随访,根据患者是否使用抗HBV药物,分为抗HBV治疗组及对照组,比较使用DMARDs治疗前、治疗后患者肝功能、乙肝两对半、HBV-DNA等结果及患者HBV再激活情况。结果 17例患者中共有6例(35.3%)患者出现HBV再激活,其中抗HBV治疗组7例患者均未出现HBV再激活;对照组10例患者中6例(60.0%)患者在DMARDs治疗3~36月时出现HBV再激活,其中1例患者出现肝衰竭,两组HBV再激活率差异有统计学意义(OR=2.5,P<0.05);使用糖皮质激素组较未用糖皮质激素组HBV再激活率升高,差异有统计学意义(OR=5.0,P<0.05)。结论未预防性抗HBV治疗的HB-s Ag阳性RA患者经DMARDs治疗后可使HBV再激活率升高,尤其使用糖皮质激素者HBV再激活风险高,预防性抗HBV治疗可有效阻止HBV再激活。
Objective To investigate the efficacy and safety of oral modification of disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA) who have surface antigen of hepatitis B (HBs Ag) Effect of anti-hepatitis B virus (HBV) treatment on HBV reactivation. Methods From January 2012 to January 2016, 17 HBsAg-positive RA patients were followed up. According to whether the patients were using anti-HBV drugs or not, the patients were divided into anti-HBV treatment group and control group. The changes of liver function before and after treatment with DMARDs , Hepatitis B two and a half, HBV-DNA and other results and patients with HBV reactivation. Results HBV reactivation occurred in 6 of 17 patients (35.3%), of which 7 patients in anti-HBV group did not reactivate HBV. 6 of 10 patients (60.0%) in control group were treated with DMARDs 3 HBV reactivation occurred at ~ 36 months, of which 1 case had liver failure. The HBV reactivation rate was significantly different between the two groups (OR = 2.5, P <0.05). Compared with the glucocorticoid group HBV reactivation rate increased, the difference was statistically significant (OR = 5.0, P <0.05). Conclusions Unprotected anti-HBV treatment of HB-s Ag-positive RA patients after DMARDs treatment can increase the rate of HBV reactivation, especially glucocorticoid re-activation of HBV is high, prophylactic anti-HBV treatment can effectively prevent HBV and then activation.