免疫抑制剂致乙肝病毒再激活的临床分析

目的 探讨需要使用免疫抑制剂的乙肝病毒（HBV）感染者使用免疫抑制剂后乙肝病毒再激活的发生及其抗病毒治疗的收益.方法 收集我院近3年收治的46例使用免疫抑制剂患者的临床资料,并分析其免疫抑制剂类型、肝脏损害程度及抗病毒治疗情况.结果 出现乙肝再激活17例（37.0%）,发生重症肝炎6例（13.0%）.接受拉米夫定预防性抗病毒治疗的患者有80%HBV DNA下降,乙肝再激活后再行抗病毒治疗的7例患者中,2例死于肝衰竭.未作抗病毒治疗的患者中有10例（47.6%）乙肝病毒再激活.结论 所有需要使用免疫抑制剂的患者在用药前需要进行常规的HBV筛查,对存在HBV感染的患者需要考虑到HBV再激活.使用强烈的免疫抑制剂、糖皮质激素以及低龄、男性患者容易发生乙肝再激活.对具有高危因素的患者需要及时使用抗病毒药物,抗病毒药物的使用可以降低病毒再激活的风险.

Clinical analysis of Hepatitis B virus (HBV) reactivation caused by immunosuppressive therapy

Objeetive To investigate the Hepatitis B virus （HBV） reactivation in patients with HBV infection and undergoing immunosuppressive therapy, and to evaluate the benefit of anti-HBV therapy. Methods 46 HBV infected patients undergoing immunosuppressive therapy were retrospectively stud- ied. Results 17 （ 37.0% ） patients developed HBV reactivation. Among them, 6 （ 13.0% ） had severe hepatitis. HBV DNA copies levels were reduced in 80% of patients received prophylactic lamivudine treatment. 7 patients received antiviral therapies after the diagnosis of HBV reactivation, and 2 of them died from hepatic failure. There were 10 of 21 （47.6%） patients did not receive antiviral therapy resulted in HBV reactivation. Conclusion All patients should be detected for HBV infection before application of im- munosuppressive therapy. Intensive immunosuppressive agents, glucocorticoid, young age, male might be high risk factors of HBV reactivation. Patients with high risk factors should receive antiviral therapy, which may reduce the HBV reactivation.