肿瘤坏死因子α拮抗药致乙型肝炎病毒再活化的临床观察

Clinical Observation of the Reactivation of Hepatitis B Virus Induced by Tumor Necrosis Factor-α Antagonist

目的:观察应用肿瘤坏死因子α(TNF-α)拮抗药治疗,是否导致非活动性乙型肝炎病毒(HBV)携带者病毒再活化。方法:总结分析47例在我院门诊和病房接受TNF-α拮抗药的无活动性病变的HBV携带者临床资料,所有患者在用药前HBsAg阳性,HBV-DNA低于检测下限(<5×10~2IU.mL^(-1)),天门冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)正常,治疗前及治疗后定期观察其肝功能、HBV-DNA、病毒血清学指标等。结果:2例非活动性HBV携带者在使用英夫利昔单抗治疗后出现HBV再活化,其中1例Crohn病患者在治疗开始22周准备第5次注射英夫利昔单抗前检查发现HBV再活化,另1例类风湿性关节炎患者在14周准备第4次注射英夫利昔单抗前检查发现HBV再活化。2例患者均给予拉米夫定抗病毒治疗,2月后复查,患者ALT、AST均恢复正常,HBV-DNA低于检测下限。结论:应用TNF-α拮抗药治疗肝功能正常、HBV-DNA低于检测下限的非活动性HBV携带者可能出现HBV再活化。

OBJECTIVE：To observe whether the therapy of tumor necrosis factor-α（TNF-α）antagonist can influence the reactivation of hepatitis B virus（HBV）infection in inactive HBV carriers.METHODS：The medical records of 47 inactive HBV carriers who had been treated with TNF-α antagonist in outpatient department and wards of our hospital were reviewed retrospectively,and all of them had normal level of AST and ALT,positive HBsAg and HBV-DNA load posterior to the lowest detection limit（〈5×10^2IU·mL^-1）before medication.The liver function,HBV-DNA and virus serology index were observed before and after treatment.RESULTS：Reactivation of HBV occurred in 2 patients during the course of anti-TNF-α therapy.Among which 1 patient with Crohn disease returned for the fifth infusion of infliximab at 22th week,and blood test showed the reactivation of HBV infection;another patient with RA returned for the fourth infusion of infliximab at 14th week,then the reactivation of HBV infection occurred.Both patients received lamivudine and the AST and ALT levels returned to normal and HBV-DNA was lower than the lowest detection limit after 2 months.CONCLUSION：Therapy of TNF-α may influence normal liver function.The reactivation of HBV infection might happen in inactive HBV carriers whose HBV-DNA is lower than the lowest detection limit.