Center for Rheumatic Diseases, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
Mod Rheumatol. 2012 Jun;22(3):470-3. doi: 10.1007/s10165-011-0521-9. Epub 2011 Sep 8.
Immunosuppressive therapy can induce viral reactivation in patients with chronic hepatitis B virus (HBV) infection and, more rarely, in patients with resolved HBV infection. We report the case of a 57-year-old Japanese woman with rheumatoid arthritis (RA) who developed de-novo hepatitis B virus-related hepatitis after methotrexate (MTX) therapy. Entecavir and oral prednisolone following steroid pulse therapy were administered and her liver function recovered. MTX is widely used for RA for its efficiency and safety. But some cases of HBV reactivation caused by MTX, including de-novo hepatitis, have been reported. Considering these conditions, more attention should be paid when using MTX in patients with RA. And more studies are needed to determine who needs screening of HBV, monitoring of HBV-DNA, and prophylaxis with chemotherapy or immunosuppressive therapy.
免疫抑制疗法可诱导慢性乙型肝炎病毒（HBV）感染患者病毒再激活，在极少数情况下，也可诱导已清除 HBV 感染患者病毒再激活。我们报告了一例 57 岁日本女性类风湿关节炎（RA）患者，在接受甲氨蝶呤（MTX）治疗后发生乙型肝炎病毒相关肝炎。给予恩替卡韦和口服泼尼松龙治疗后，患者肝功能恢复正常。MTX 因其疗效和安全性而被广泛用于 RA。但已有 MTX 导致 HBV 再激活的病例报告，包括新发肝炎。鉴于这些情况，在使用 MTX 治疗 RA 患者时应更加注意。还需要更多的研究来确定谁需要筛查 HBV、监测 HBV-DNA，以及是否需要用化疗或免疫抑制疗法进行预防。
