Canzoni Marco, Marignani Massimo, Sorgi Maria Laura, Begini Paola, Biondo Michela Ileen, Caporuscio Sara, Colonna Vincenzo, Casa Francesca Della, Conigliaro Paola, Marrese Cinzia, Celletti Eleonora, Modesto Irene, Peragallo Mario Stefano, Laganà Bruno, Picchianti-Diamanti Andrea, Rosa Roberta Di, Ferlito Claudia, Salemi Simonetta, D'Amelio Raffaele, Stroffolini Tommaso
UOC di Immunologia Clinica e Reumatologia, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy.
UOC Malattie Apparato Digerente e Fegato, Sapienza Università di Roma, AOU S. Andrea, 00189 Roma, Italy.
Microorganisms. 2020 Nov 16;8(11):1792. doi: 10.3390/microorganisms8111792.
Chronic hepatitis B virus (HBV) infection may be reactivated by immunosuppressive drugs in patients with autoimmune inflammatory rheumatic diseases. This study evaluates HBV serum markers' prevalence in rheumatic outpatients belonging to Spondyloarthritis, Chronic Arthritis and Connective Tissue Disease diagnostic groups in Italy. The study enrolled 302 subjects, sex ratio (M/F) 0.6, mean age ± standard deviation 57 ± 15 years, 167 (55%) of whom were candidates for immunosuppressive therapy. The Spondyloarthritis group included 146 subjects, Chronic Arthritis 75 and Connective Tissue Disease 83 (two patients had two rheumatic diseases; thus, the sum is 304 instead of 302). Ten subjects (3%) reported previous anti-HBV vaccination and tested positive for anti-HBs alone with a titer still protective (>10 IU/mL). Among the remaining 292 subjects, the prevalence of positivity for HBsAg, isolated anti-HBc, anti-HBc/anti-HBs, and any HBV marker was 2%, 4%, 18%, and 24%, respectively. A total of 26/302 (9%) patients with γ-globulin levels ≤0.7 g/dL were more frequently ( = 0.03455) prescribed immunosuppressive therapy, suggesting a more severe rheumatic disease. A not negligible percentage of rheumatic patients in Italy are at potential risk of HBV reactivation related to immunosuppressive therapy. Before starting treatment, subjects should be tested for HBV markers. Those resulting positive should receive treatment or prophylaxis with Nucleos (t) ides analogue (NUCs) at high barrier of resistance, or pre-emptive therapy, according to the pattern of positive markers. HB vaccination is recommended for those who were never exposed to the virus.
自身免疫性炎性风湿性疾病患者使用免疫抑制药物可能会激活慢性乙型肝炎病毒（HBV）感染。本研究评估了意大利脊柱关节炎、慢性关节炎和结缔组织病诊断组的风湿门诊患者中HBV血清标志物的流行情况。该研究纳入了302名受试者，男女比例（男/女）为0.6，平均年龄±标准差为57±15岁，其中167名（55%）为免疫抑制治疗候选者。脊柱关节炎组包括146名受试者，慢性关节炎组75名，结缔组织病组83名（两名患者患有两种风湿性疾病；因此，总数为304名而非302名）。10名受试者（3%）报告曾接种抗HBV疫苗，仅抗-HBs检测呈阳性，且滴度仍具有保护性（>10 IU/mL）。在其余292名受试者中，HBsAg、单独抗-HBc、抗-HBc/抗-HBs及任何HBV标志物阳性的患病率分别为2%、4%、18%和24%。共有26/302（9%）名γ-球蛋白水平≤0.7 g/dL的患者更频繁地（P = 0.03455）接受免疫抑制治疗，提示风湿性疾病更严重。在意大利，不可忽视比例的风湿性患者存在与免疫抑制治疗相关的HBV激活潜在风险。在开始治疗前，应检测受试者的HBV标志物。根据阳性标志物模式，检测结果呈阳性者应接受具有高耐药屏障的核苷（酸）类似物（NUCs）治疗或预防，或进行抢先治疗。对于从未接触过该病毒的患者建议接种HB疫苗。
