Lin Ying-Cheng, Chen Yen-Ju, Lee Shou-Wu, Lee Teng-Yu, Chen Yi-Hsing, Huang Wen-Nan, Yang Sheng-Shun, Chen Yi-Ming
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.
J Clin Med. 2021 Jul 26;10(15):3296. doi: 10.3390/jcm10153296.
The risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-negative, antibody to hepatitis B core antigen (anti-HBc)-positive patients after glucocorticoid (GC) pulse therapy remains unclear.
Our study aimed to examine the safety of GC pulse therapy in HBsAg-negative, anti-HBc-positive rheumatic patients.
Medical records of HBsAg-negative, anti-HBc-positive patients receiving GC pulse therapy to treat rheumatic diseases were reviewed. The primary outcome was HBV-associated hepatitis occurring within the first year after GC pulse therapy; the secondary outcome was HBsAg seroreversion occurring during the follow-up period.
We identified 5222 HBsAg-negative, anti-HBc-positive patients with rheumatic diseases who had attended Taichung Veterans General Hospital from October 2006 to December 2018. A total of 689 patients had received GC pulse therapy, with 424 patients being analyzed. Hepatitis was noted in 28 patients (6.6%) within the first year after GC pulse therapy, but none had been diagnosed as HBV-associated hepatitis. Three patients (0.7%) later developed HBsAg seroreversion, with a median interval of 97 months from the first episode of GC pulse therapy. These cases concurrently had maintained high dose oral prednisolone (≥20 mg prednisolone daily for over 4 weeks).
Amongst the HBsAg-negative, anti-HBc-positive rheumatic patients treated with GC pulse therapy, the risk of HBV-associated hepatitis within the first year was low. HBsAg seroreversion may have developed in the later stage, but only in those patients who had maintained high-dose oral steroid.
在接受糖皮质激素（GC）脉冲治疗的乙肝表面抗原（HBsAg）阴性、乙肝核心抗体（抗-HBc）阳性患者中，乙肝病毒（HBV）再激活的风险仍不明确。
我们的研究旨在探讨GC脉冲治疗在HBsAg阴性、抗-HBc阳性风湿性疾病患者中的安全性。
回顾了接受GC脉冲治疗以治疗风湿性疾病的HBsAg阴性、抗-HBc阳性患者的病历。主要结局是GC脉冲治疗后第一年内发生的HBV相关性肝炎；次要结局是随访期间发生的HBsAg血清学逆转。
我们确定了2006年10月至2018年12月在台中荣民总医院就诊的5222例患有风湿性疾病的HBsAg阴性、抗-HBc阳性患者。共有689例患者接受了GC脉冲治疗，其中424例患者接受分析。在GC脉冲治疗后第一年内，28例患者（6.6%）出现肝炎，但均未被诊断为HBV相关性肝炎。3例患者（0.7%）后来出现HBsAg血清学逆转，从首次GC脉冲治疗发作起的中位间隔时间为97个月。这些病例同时维持高剂量口服泼尼松龙（≥20mg泼尼松龙每日超过4周）。
在接受GC脉冲治疗的HBsAg阴性、抗-HBc阳性风湿性疾病患者中，第一年内发生HBV相关性肝炎的风险较低。HBsAg血清学逆转可能在后期出现，但仅发生在维持高剂量口服类固醇的患者中。
