Hatano Masako, Mimura Toshihide, Shimada Akira, Noda Mitsuhiko, Katayama Shigehiro
Department of Endocrinology and Diabetes Saitama Medical University Saitama Japan.
Department of Rheumatology and Applied Immunology, Faculty of Medicine Saitama Medical University Saitama Japan.
Endocrinol Diabetes Metab. 2019 May 9;2(3):e00071. doi: 10.1002/edm2.71. eCollection 2019 Jul.
Whether or not reactivation of hepatitis B virus (HBV) might occur during corticosteroid therapy in hepatitis B surface antigen (HBsAg)-negative patients with adrenal insufficiency was investigated.
We consecutively enrolled 66 patients with adrenal insufficiency undergoing physiological corticosteroid replacement therapy at Saitama Medical University Hospital between June 2013 and June 2014, and 220 patients with rheumatic disease receiving a pharmacologic dose of corticosteroids served as the positive control group. The latter group was separated into 101 patients treated only with corticosteroids, and 119 patients given corticosteroids plus immunosuppressants and/or disease-modifying antirheumatic drugs (DMARDs). HBsAg and antibody (Ab) levels against HBs, and hepatitis B core (HBc) were determined in all the patients. In patients with positive HBsAb and/or HBcAb, real-time PCR was performed for HBV-DNA. The incidence rates of conversion to HBV-DNA-positive status were evaluated.
Hepatitis B virus reactivation occurred in six patients with rheumatic disease, three of whom were receiving a pharmacological dose of corticosteroids only, and three who were receiving corticosteroids with immunosuppressants and/or DMARDs. However, no reactivation occurred in patients receiving corticosteroid replacements for adrenal insufficiency. Maintenance and maximum corticosteroid doses administered to patients with rheumatic disease were significantly greater than those in patients with adrenal insufficiency.
These results suggest that, although corticosteroid replacement therapy for adrenal insufficiency might be safe with respect to HBV reactivation, attention should be paid to HBV reactivation during corticosteroid therapy in rheumatic disease patients, since the dose of corticosteroids administered is usually large, and since other immunosuppressants are co-administered.
研究肾上腺功能不全且乙肝表面抗原（HBsAg）阴性的患者在接受皮质类固醇治疗期间是否会发生乙肝病毒（HBV）再激活。
2013年6月至2014年6月期间，我们连续纳入了66例在埼玉医科大学医院接受生理性皮质类固醇替代治疗的肾上腺功能不全患者，并将220例接受药理剂量皮质类固醇治疗的风湿性疾病患者作为阳性对照组。后一组患者分为仅接受皮质类固醇治疗的101例患者，以及接受皮质类固醇加免疫抑制剂和/或改善病情抗风湿药（DMARDs）治疗的119例患者。测定了所有患者的HBsAg、乙肝表面抗体（HBsAb）及乙肝核心抗体（HBc）水平。对于HBsAb和/或HBcAb阳性的患者，进行了HBV-DNA的实时聚合酶链反应检测。评估了转为HBV-DNA阳性状态的发生率。
6例风湿性疾病患者发生了乙肝病毒再激活，其中3例仅接受药理剂量的皮质类固醇治疗，3例接受皮质类固醇与免疫抑制剂和/或DMARDs联合治疗。然而，接受肾上腺功能不全皮质类固醇替代治疗的患者未发生再激活。风湿性疾病患者的维持和最大皮质类固醇剂量显著高于肾上腺功能不全患者。
这些结果表明，尽管肾上腺功能不全的皮质类固醇替代治疗在HBV再激活方面可能是安全的，但在风湿性疾病患者的皮质类固醇治疗期间应注意HBV再激活，因为通常给予的皮质类固醇剂量较大，且同时使用了其他免疫抑制剂。
