免疫抑制治疗对HBsAg阳性炎症性肠病患者HBV再活动的影响
发布时间：2018-09-07 21:48
【摘要】：目的探讨不同免疫抑制治疗方案在乙肝表面抗原(HBs Ag)阳性炎症性肠病(IBD)患者中的应用安全性。方法检索2005年1月-2015年1月在北京协和医院住院诊治的IBD患者,筛选出其中HBs Ag阳性者进行回顾性研究,记录其一般情况、IBD的诊断及治疗方案、HBV感染的临床类型及治疗方案,以及IBD治疗前后患者肝功及HBV临床类型的变化。结果共检索到IBD患者1 259例,其中HBs Ag阳性者54例,IBD患者中HBs Ag的阳性率为4.29%;溃疡性结肠炎(UC)和克罗恩病(CD)患者中HBs Ag的阳性率分别为2.89%和8.28%(P0.001)。在临床资料完整的51例患者中,38例应用免疫抑制治疗,8例出现HBV再活动,其中全身激素治疗组6例,激素灌肠组1例,类克治疗组1例,再活动出现在免疫抑制治疗后3周~12个月;21例免疫抑制治疗前开始抗乙肝病毒治疗的患者中仅1例(4.76%)出现HBV再活动,而17例未抗病毒的患者中7例(41.18%)出现HBV再活动,差异有统计学意义(P=0.013)。51例患者中26例在IBD治疗前未行抗病毒治疗,其中7例(26.92%)出现HBV再活动,不同IBD治疗方案对HBV再活动的总体影响有显著性差异(P=0.008),其中全身激素治疗组与美沙拉嗪对照组之间差异有统计学意义(P0.001)。结论 CD患者中HBs Ag的阳性率高于UC患者;激素灌肠、全身激素治疗及类克治疗均可导致HBV再活动,其中全身激素治疗的再活动率最高;预防性抗病毒治疗可有效预防HBV再活动。
[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.
【作者单位】： 中国医学科学院北京协和医学院北京协和医院消化内科;
【基金】：卫生行业科研专项基金(No.201002020)
【分类号】：R574.62;R512.62
本文编号：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.
【作者单位】： 中国医学科学院北京协和医学院北京协和医院消化内科;
【基金】：卫生行业科研专项基金(No.201002020)
【分类号】：R574.62;R512.62
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1 李廷青，赵宪;炎症性肠病性腹泻[J];中国实用内科杂志;1995年07期
2 程远;王静;程计林;;乙型、丙型肝炎与炎症性肠病[J];胃肠病学和肝病学杂志;2009年10期
3 张春平,王桂荣;早期麻疹病毒感染与炎症性肠病的发病有关[J];国外医学(内科学分册);2001年05期
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