风湿病免疫抑制剂治疗致乙肝病毒再激活的临床观察.pdf

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1、·临床探讨·中国现代医生2014年1月第52卷第3期风湿病免疫抑制剂治疗致乙肝病毒再激活的临床观察高利霞观美华王飞马永华钟彩玲广东省湛江中心人民医院血液风湿科，广东湛江524037【摘要】目的探讨风湿病患者使用免疫抑制剂过程中乙肝病毒再激活的发生情况及抗病毒治疗的效果。方法26例风湿病患者被分为组，HBV复制组(HBsAg阳性+HBV—DNA阳性)：免疫抑制剂治疗前1周加用抗病毒药拉米夫定100mg／d；HBV无复制组(HBsAg阳性+HBV—DNA阴性)：免疫抑制剂治疗前先不加抗病毒药物．随访中如

2、出现HBV—DNA转阳则加用抗病毒药拉米夫定100md治疗，既往暴露组(HBsAg阴性+抗HBc阳性)：随访中出现HBsAg或HBV—DNA转阳加用抗病毒治疗。结果HBV复制组11／13出现HBV—DNA转阴：HBV无复制组4111出现HBV—DNA转阳：既往暴露组1／2出现HBV—DNA转阳，这5例发生再激活的患者予拉米夫定治疗后HBV—DNA均转阴。结论合并乙型病毒性肝炎的风湿病患者使用免疫抑制剂治疗可能会导致HBV再激活，一旦出现再激活则需及时采取抗病毒治疗。对于HBsAg阳性同时HBV—DN

3、A阴性的风湿病患者，免疫抑制剂治疗前可能需要进行预防性抗病毒治疗。不能忽视既往暴露的患者，需密切监测乙肝两对半及HBV—DNA的变化。『关键词】风湿病；免疫抑制；乙肝病毒；再激活【中图分类号】R512．62[文献标识码】B[文章编号】1673—9701(2014)03—0142—04ClinicalobservationofHepatitisBvirus(HBV)reactivationcausedbyimmunosuppressivetherapyofrheumaticdiseaseGA0Lixi

4、aGUANMeihuaWANGFeiMAYonghuaZHONGCailingDepartmentofHematologyandRheumatology，ZhanjiangCenterPeople’SHospitalAfiliatedtoGuangdongMedicalU—niversity，Guangdong，Zhanjiang524037，China【Abstract】ObjectiveToinvestigatetheHepatitisBVirus(HBV)reactivationinthepr

5、ocessofimmun0suppressivetherapyofrheumaticdisease，andtoevaluatetheeffectofanti—HBVtherapy．MethodsAlltheresearchobjectisdivid—edintothreegroups：inHBVactivegrouppatientsreceived100mgoflamivudineoncedailyoneweekbeforetheyweretreatedwithimmunosuppressive；i

6、nHBVinactivegrouppatientsweretreatedwithimmunosuppressivebutwithoutantiviraldrugatfirst，thepatientswhoseHBV—DNAbecomepositiveduringthetreatmentabovewouldreceivedlO0mgoflamivudineoncedailyoneweek；inalwaysexposuregrouppatientswouldreceivedlOOmgoflamivudi

7、neoncedailyoneweek，ifHBsAgorHBV—DNAbecomepositiveduringthetreatment．ResultsInHBVactivegroupHBV-DNAturnedtonegativein11of13patientsanddecreasedinother2patients；inHBVinactivegroupHBV-DNAturnedtopositivein4of14patients；inalwaysexposuregroupHBV—DNAturnedto

8、positivein1of2patients；thefivepatientswithHBVreactivationHBV-DNAturnedtonegativeafterweretreatedwithlamivudine．Conclusionrheumatismpa—tientswithHBVuseimmunosuppressivetherapymayresultinHBVreactivation．Itiswillbetakeantiviraltreatmenttim