Ye Hua, Zhang Xue-wu, Mu Rong, Fang Lin-kai, Gu Jie-ruo, Lin Jin, Du Jin-feng, Chen Jin-wei, Chen Yi-jia, Wu Li-jun, Pang Xue-feng, Li Zhan-guo
Clin Rheumatol. 2014 Jan;33(1):119-23. doi: 10.1007/s10067-013-2385-1.
This study aims to investigate the incidence of hepatitis B virus (HBV) reactivation in inflammatory arthritis (IA) patients with HBV infection using anti-tumor necrosis factor (TNF) agents and evaluate the efficacy of antiviral therapy in reducing the risk of viral reactivation in chronic HBV infection. IA patients using anti-TNF agents from six centers were enrolled. Their HBV infection conditions and ALT and HBV-DNA levels were monitored periodically. Among the six chronic hepatitis B patients, HBV reactivation was found in two patients without antivirus prophylaxis and no viral replication was detected in the other four patients with antivirus prophylaxis. In the 31 inactive carriers, the increase of viral load was detected in 6 of 22 (27.3 %) patients without antiviral prophylaxis, and there was no viral reactivation in the other 9 patients with antiviral prophylaxis. HBV reactivation was not found in the 50 patients with resolved HBV infection. It is suggested that anti-TNF therapy might increase the risk of HBV reactivation in patients with chronic HBV infection, and antiviral prophylaxis could effectively decrease the risk. Anti-TNF agents seem to be safe in patients with resolved HBV infection.
本研究旨在调查使用抗肿瘤坏死因子（TNF）药物的炎症性关节炎（IA）合并乙型肝炎病毒（HBV）感染患者中HBV再激活的发生率，并评估抗病毒治疗在降低慢性HBV感染中病毒再激活风险的疗效。招募了来自六个中心使用抗TNF药物的IA患者。定期监测他们的HBV感染情况以及ALT和HBV-DNA水平。在六例慢性乙型肝炎患者中，两名未进行抗病毒预防的患者出现了HBV再激活，而其他四名进行了抗病毒预防的患者未检测到病毒复制。在31例非活动性携带者中，22例（27.3%）未进行抗病毒预防的患者中有6例检测到病毒载量增加，而其他9例进行了抗病毒预防的患者未出现病毒再激活。50例已治愈HBV感染的患者未发现HBV再激活。提示抗TNF治疗可能会增加慢性HBV感染患者HBV再激活的风险，而抗病毒预防可有效降低该风险。抗TNF药物在已治愈HBV感染的患者中似乎是安全的。
