接受直接作用抗病毒治疗或基于干扰素的治疗丙型肝炎的患者中的乙型肝炎病毒再激活：系统评价和荟萃分析。
Hepatitis B reactivation in patients receiving direct-acting antiviral therapy or interferon-based therapy for hepatitis C: A systematic review and meta-analysis.
机构信息
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2018 Jul 28;24(28):3181-3191. doi: 10.3748/wjg.v24.i28.3181.
AIM
To assess the incidence of hepatitis B virus (HBV) reactivation in patients receiving direct-acting antiviral agent (DAA)-based therapy or interferon (IFN)-based therapy for hepatitis C and the effectiveness of preemptive anti-HBV therapy for preventing HBV reactivation.
METHODS
The PubMed, MEDLINE and EMBASE databases were searched, and 39 studies that reported HBV reactivation in HBV/hepatitis C virus coinfected patients receiving DAA-based therapy or IFN-based therapy were included. The primary outcome was the rate of HBV reactivation. The secondary outcomes included HBV reactivation-related hepatitis and the effectiveness of preemptive anti-HBV treatment with nucleos(t)ide analogues. The pooled effects were assessed using a random effects model.
RESULTS
The rate of HBV reactivation was 21.1% in hepatitis B surface antigen (HBsAg)-positive patients receiving DAA-based therapy and 11.9% in those receiving IFN-based therapy. The incidence of hepatitis was lower in HBsAg-positive patients with undetectable HBV DNA compared to patients with detectable HBV DNA receiving DAA therapy (RR = 0.20, 95%CI: 0.06-0.64, = 0.007). The pooled HBV reactivation rate in patients with previous HBV infection was 0.6% for those receiving DAA-based therapy and 0 for those receiving IFN-based therapy, and none of the patients experienced a hepatitis flare related to HBV reactivation. Preemptive anti-HBV treatment significantly reduced the potential risk of HBV reactivation in HBsAg-positive patients undergoing DAA-based therapy (RR = 0.31, 95%CI: 0.1-0.96, = 0.042).
CONCLUSION
The rate of HBV reactivation and hepatitis flare occurrence is higher in HBsAg-positive patients receiving DAA-based therapy than in those receiving IFN-based therapy, but these events occur less frequently in patients with previous HBV infection. Preemptive anti-HBV treatment is effective in preventing HBV reactivation.
目的
评估接受直接作用抗病毒药物（DAA）或干扰素（IFN）治疗丙型肝炎的患者中乙型肝炎病毒（HBV）再激活的发生率，以及预防性抗 HBV 治疗预防 HBV 再激活的效果。
方法
检索 PubMed、MEDLINE 和 EMBASE 数据库，纳入了 39 项报告 DAA 治疗或 IFN 治疗的 HBV/丙型肝炎病毒合并感染患者中 HBV 再激活的研究。主要结局为 HBV 再激活率。次要结局包括 HBV 再激活相关肝炎和核苷（酸）类似物预防性抗 HBV 治疗的效果。采用随机效应模型评估汇总效应。
结果
HBsAg 阳性接受 DAA 治疗的患者中 HBV 再激活率为 21.1%，接受 IFN 治疗的患者为 11.9%。与 DAA 治疗中 HBV DNA 可检测的患者相比，HBV DNA 不可检测的 HBsAg 阳性患者发生肝炎的风险较低（RR=0.20，95%CI：0.06-0.64， = 0.007）。既往 HBV 感染者接受 DAA 治疗的患者中 HBV 再激活率为 0.6%，接受 IFN 治疗的患者为 0%，且无患者发生与 HBV 再激活相关的肝炎发作。预防性抗 HBV 治疗可显著降低 HBsAg 阳性患者接受 DAA 治疗时发生 HBV 再激活的潜在风险（RR=0.31，95%CI：0.1-0.96， = 0.042）。
结论
与接受 IFN 治疗的患者相比，接受 DAA 治疗的 HBsAg 阳性患者中 HBV 再激活和肝炎发作的发生率更高，但在既往 HBV 感染者中这些事件的发生率较低。预防性抗 HBV 治疗可有效预防 HBV 再激活。
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