Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
J Viral Hepat. 2021 May;28(5):809-816. doi: 10.1111/jvh.13481. Epub 2021 Feb 14.
Hepatitis B virus (HBV) infection has been proposed to play a role in the development of Sjögren's syndrome. However, to date, there are no reports on the risk of SS in HBV-infected patients following nucleos(t)ide analogue therapy. Due to Taiwan has higher prevalence of HBV infection and therapy was well recorded in the Taiwan's single-payer national health insurance database, we hypothesized that a long-term retrospective analysis of the risk of Sjögren's syndrome in HBV-infected patients following nucleotide therapy will increase our understanding of Sjögren's syndrome development following HBV infection. We identified 26,147 adults diagnosed with HBV infection between 1997 and 2012 in claims data. Finally, a total of 3268 HBV-infected patients who ever received nucleotide therapy (treated cohort) were frequency-matched on age and sex at 1:4 ratios to select a control group of 13,072 counterparts without therapy (untreated cohort). To identify Sjögren's syndrome risk, competing risk analysis adjusted for all covariates was performed. The risk was significantly lower in the treated cohort (15-year cumulative incidence, 2.4%; 95% confidence interval [CI], 1.4%-3.7%) than in the untreated cohort (7.1%; 95% CI, 2.5%-15.2%) (p = .015), and the adjusted HR was 0.6 (95% CI, 0.41-0.88; p = .009). Multivariable stratified analysis further verified the consistent associations between nucleoside therapy and risk reduction of Sjögren's syndrome across all strata. Our finding suggests that HBV infection treated with nucleotides is associated with lower risk of Sjögren's syndrome, implying a potential role of HBV infection in the development of Sjögren's syndrome.
乙型肝炎病毒 (HBV) 感染被认为在干燥综合征的发病机制中起作用。然而，迄今为止，尚无核苷（酸）类似物治疗后 HBV 感染患者发生干燥综合征的风险报道。由于台湾地区 HBV 感染率较高，且治疗情况在台湾全民健康保险单一支付方数据库中得到了很好的记录，我们假设对 HBV 感染患者接受核苷酸治疗后发生干燥综合征的风险进行长期回顾性分析，将有助于我们了解 HBV 感染后干燥综合征的发病机制。我们从理赔数据中确定了 1997 年至 2012 年间 26147 例成人乙型肝炎病毒感染者。最终，共纳入 3268 例接受过核苷酸治疗的 HBV 感染者（治疗组），并按照年龄和性别以 1:4 的比例进行频数匹配，选择 13072 例未接受治疗的 HBV 感染者作为对照组（未治疗组）。为了确定干燥综合征的发病风险，我们采用竞争风险分析对所有协变量进行了调整。治疗组（15 年累积发病率为 2.4%，95%置信区间为 1.4%-3.7%）的发病风险明显低于未治疗组（7.1%，95%置信区间为 2.5%-15.2%）（p = 0.015），调整后的 HR 为 0.6（95%CI，0.41-0.88；p = 0.009）。多变量分层分析进一步验证了核苷酸治疗与干燥综合征发病风险降低之间的一致性关联，在所有分层中均存在这种关联。我们的研究结果表明，接受核苷酸治疗的 HBV 感染与干燥综合征发病风险降低相关，这提示 HBV 感染在干燥综合征的发病机制中起潜在作用。
