免疫抑制治療對HBsAg陽性炎癥性腸病患者HBV再活動的影響
發(fā)布時間：2018-09-07 21:48
【摘要】：目的探討不同免疫抑制治療方案在乙肝表面抗原(HBs Ag)陽性炎癥性腸病(IBD)患者中的應(yīng)用安全性。方法檢索2005年1月-2015年1月在北京協(xié)和醫(yī)院住院診治的IBD患者,篩選出其中HBs Ag陽性者進(jìn)行回顧性研究,記錄其一般情況、IBD的診斷及治療方案、HBV感染的臨床類型及治療方案,以及IBD治療前后患者肝功及HBV臨床類型的變化。結(jié)果共檢索到IBD患者1 259例,其中HBs Ag陽性者54例,IBD患者中HBs Ag的陽性率為4.29%;潰瘍性結(jié)腸炎(UC)和克羅恩病(CD)患者中HBs Ag的陽性率分別為2.89%和8.28%(P0.001)。在臨床資料完整的51例患者中,38例應(yīng)用免疫抑制治療,8例出現(xiàn)HBV再活動,其中全身激素治療組6例,激素灌腸組1例,類克治療組1例,再活動出現(xiàn)在免疫抑制治療后3周~12個月;21例免疫抑制治療前開始抗乙肝病毒治療的患者中僅1例(4.76%)出現(xiàn)HBV再活動,而17例未抗病毒的患者中7例(41.18%)出現(xiàn)HBV再活動,差異有統(tǒng)計學(xué)意義(P=0.013)。51例患者中26例在IBD治療前未行抗病毒治療,其中7例(26.92%)出現(xiàn)HBV再活動,不同IBD治療方案對HBV再活動的總體影響有顯著性差異(P=0.008),其中全身激素治療組與美沙拉嗪對照組之間差異有統(tǒng)計學(xué)意義(P0.001)。結(jié)論 CD患者中HBs Ag的陽性率高于UC患者;激素灌腸、全身激素治療及類克治療均可導(dǎo)致HBV再活動,其中全身激素治療的再活動率最高;預(yù)防性抗病毒治療可有效預(yù)防HBV再活動。
[Abstract]:Objective to investigate the safety of immunosuppressive therapy in (IBD) patients with hepatitis B surface antigen (HBs Ag) positive inflammatory bowel disease. Methods A retrospective study was conducted on IBD patients who were hospitalized in Peking Union Hospital from January 2005 to January 2015. The HBs Ag positive patients were selected for retrospective study, and the clinical types and treatment schemes of HBs Ag infection were recorded. And the changes of liver function and HBV before and after IBD treatment. Results A total of 1 259 cases of IBD were found. The positive rate of HBs Ag was 4.29% in 54 patients with HBs Ag positive, 2.89% in (UC) patients with ulcerative colitis and 8.28% in (CD) patients with Crohn's disease (P0.001). Among the 51 patients with complete clinical data, 38 cases were treated with immunosuppressive therapy and 8 cases had HBV reactivity. There were 6 cases in systemic hormone therapy group, 1 case in hormone enema group and 1 case in similar treatment group. Among 21 patients who began anti-HBV therapy before immunosuppressive therapy, only 1 case (4.76%) showed HBV reactivity, while 7 cases (41.18%) of 17 patients without antiviral therapy showed HBV reactivity. The reactivity occurred in 21 patients (4.76%) from 3 weeks to 12 months after immunosuppressive therapy, and HBV reactivity occurred in 7 (41.18%) of 17 patients without antiviral therapy. The difference was statistically significant (P < 0.013) .26 out of 51 patients were not treated with antiviral therapy before IBD treatment, 7 of them (26.92%) had HBV reactivity. There was significant difference in the total effect of different IBD treatment regimens on the reactivity of HBV (P0. 008), and there was significant difference between the systemic hormone treatment group and the mesalazine control group (P0. 001). Conclusion the positive rate of HBs Ag in patients with CD is higher than that in patients with UC, steroid enema, steroid therapy and corticosteroid therapy can result in the reactivity of HBV, among which the reactivity rate of steroid therapy is the highest. Prophylactic antiviral therapy can effectively prevent HBV reactivity.
【作者單位】： 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院消化內(nèi)科;
【基金】：衛(wèi)生行業(yè)科研專項基金(No.201002020)
【分類號】：R574.62;R512.62
本文編號：2229514
[Abstract]:Objective to investigate the safety of immunosuppressive therapy in (IBD) patients with hepatitis B surface antigen (HBs Ag) positive inflammatory bowel disease. Methods A retrospective study was conducted on IBD patients who were hospitalized in Peking Union Hospital from January 2005 to January 2015. The HBs Ag positive patients were selected for retrospective study, and the clinical types and treatment schemes of HBs Ag infection were recorded. And the changes of liver function and HBV before and after IBD treatment. Results A total of 1 259 cases of IBD were found. The positive rate of HBs Ag was 4.29% in 54 patients with HBs Ag positive, 2.89% in (UC) patients with ulcerative colitis and 8.28% in (CD) patients with Crohn's disease (P0.001). Among the 51 patients with complete clinical data, 38 cases were treated with immunosuppressive therapy and 8 cases had HBV reactivity. There were 6 cases in systemic hormone therapy group, 1 case in hormone enema group and 1 case in similar treatment group. Among 21 patients who began anti-HBV therapy before immunosuppressive therapy, only 1 case (4.76%) showed HBV reactivity, while 7 cases (41.18%) of 17 patients without antiviral therapy showed HBV reactivity. The reactivity occurred in 21 patients (4.76%) from 3 weeks to 12 months after immunosuppressive therapy, and HBV reactivity occurred in 7 (41.18%) of 17 patients without antiviral therapy. The difference was statistically significant (P < 0.013) .26 out of 51 patients were not treated with antiviral therapy before IBD treatment, 7 of them (26.92%) had HBV reactivity. There was significant difference in the total effect of different IBD treatment regimens on the reactivity of HBV (P0. 008), and there was significant difference between the systemic hormone treatment group and the mesalazine control group (P0. 001). Conclusion the positive rate of HBs Ag in patients with CD is higher than that in patients with UC, steroid enema, steroid therapy and corticosteroid therapy can result in the reactivity of HBV, among which the reactivity rate of steroid therapy is the highest. Prophylactic antiviral therapy can effectively prevent HBV reactivity.
【作者單位】： 中國醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院北京協(xié)和醫(yī)院消化內(nèi)科;
【基金】：衛(wèi)生行業(yè)科研專項基金(No.201002020)
【分類號】：R574.62;R512.62
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