Department of Rheumatology, Osaki Citizen Hospital.
Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2020 Oct;252(2):133-141. doi: 10.1620/tjem.252.133.
The reactivation of hepatitis B virus (HBV) in patients with rheumatoid arthritis (RA) is currently a social problem. Our hospital has established a project team, which consisted of medical staff including doctors, nurses, pharmacists, and technicians, to prevent HBV reactivation and subsequent de novo hepatitis B in 2015. To verify the usefulness of the team, we aimed to examine the implementation rate of HBV screening tests in patients with RA in 2011, 2015, and 2018. We also examined the rate of HBV infection, as well as the rate of HBV reactivation during the course. In this study, medical records of patients who visited our hospital in 2011, 2015, and 2018 were retrospectively reviewed. HBV screening was completed when hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) were all examined. The prevalence of patients who completed HBV screening dramatically increased from 2.4% in 2011 to 79.1% in 2015 and 86.9% in 2018. Patients who completed the screening had significantly higher rates of liver dysfunction, methotrexate use, and use of biological disease-modifying antirheumatic drugs than those who did not. Of the 767 patients who completed HBV screening in 2018, 157 patients (20.5%) had previously resolved HBV infection (HBsAg-negative but HBsAb- and/or HBcAb-positive). During a mean follow-up of 41.0 months, reactivation of HBV was observed in 10 out of the 157 patients (6.4%); however, none developed de novo hepatitis B. In conclusion, our multidisciplinary approach to prevent de novo hepatitis B is considered useful.
乙型肝炎病毒（HBV）在类风湿关节炎（RA）患者中的再激活目前是一个社会问题。我院于 2015 年成立了一个项目团队，成员包括医生、护士、药师和技师，旨在预防 HBV 再激活和随后的新发乙型肝炎。为了验证该团队的有效性，我们旨在检查 2011 年、2015 年和 2018 年 RA 患者进行 HBV 筛查试验的实施率。我们还检查了 HBV 感染率以及治疗过程中的 HBV 再激活率。在这项研究中，回顾性分析了 2011 年、2015 年和 2018 年来我院就诊的患者的病历。当检查乙型肝炎表面抗原（HBsAg）、乙型肝炎表面抗体（HBsAb）和乙型肝炎核心抗体（HBcAb）时，完成了 HBV 筛查。完成 HBV 筛查的患者比例从 2011 年的 2.4%显著增加到 2015 年的 79.1%和 2018 年的 86.9%。完成筛查的患者肝功能障碍、甲氨蝶呤使用和生物改善病情抗风湿药物的使用率明显高于未完成筛查的患者。在 2018 年完成 HBV 筛查的 767 名患者中，157 名（20.5%）既往有 HBV 感染缓解（HBsAg 阴性但 HBsAb 和/或 HBcAb 阳性）。在平均 41.0 个月的随访中，157 名患者中的 10 名（6.4%）出现了 HBV 再激活，但均未发生新发乙型肝炎。总之，我们预防新发乙型肝炎的多学科方法被认为是有效的。
