系统性红斑狼疮合并乙型肝炎病毒感染临床分析

Clinical features of patients with systemic lupus erythematosus complicating hepatitis B virus infection

目的了解系统性红斑狼疮（SLE）合并乙型肝炎病毒（HBV）感染患者临床特点。方法回顾性分析2003年2月至2011年6月在北京协和医院住院的40例合并HBV感染的SLE患者临床资料，并与性别、发病年龄相匹配的60例无HBV感染的SLE患者比较。统计学方法采用t检验和，检验。结果40例合并HBV感染者中男性4例，女性36例，平均年龄（32±13）岁；其中23例患者表现为慢性乙型肝炎，5例为HBV携带状态，12例为既往无症状感染。21例慢性乙型肝炎患者肝功能轻度异常主要为丙氨酸转氨酶升高，2例严重肝功能异常。临床表现合并HBV感染组和对照组比较，发热、肝脏受累、肾脏受累、血小板减少、巨细胞病毒感染更常见。肾病变主要为Ⅳ型或Ⅴ型狼疮肾炎，2例合并HBV相关性肾炎。血清乙型肝炎病毒表面抗原（HBsAg）阳性的SLE患者在接受免疫抑制剂治疗时同时使用拉米夫定抗病毒治疗。患者出院好转率为98％（39／40），1例预后不佳者有严重肝脏病变。结论应重视SLE合并HBV感染患者临床特点：SLE合并HBV感染患者发热、肝脏受累、肾脏受累、血小板减少、巨细胞病毒感染者增多，可合并HBV相关性肾炎；肝脏病变严重者预后差；血清HBsAg阳性的SLE患者在接受免疫抑制剂治疗时应同时使用抗HBV药治疗。

Objective To investigate the clinical features of patients with systemic lupus erythematosus （SLE） complicating with hepatitis B virus （HBV） infection. Methods The medical records of 40 inpatients with SLE complicating with HBV infection and 60 SLE inpatients without HBV infection were analyzed retrospectively. Chisquare test and t test were used for statistical analysis. Results Forty patients with SLE complicating with HBV infection were included, including 4 men and 36 women, with the mean age of （32＋13） yr. Twenty-three patients suffered from chronic HBV hepatitis, 5 patients were serological HBsAg carriers, 12 patients with HBV ＂occult infection＂. Twenty-one patients had mild liver dysfunction, presented mainly as increased ALT, 2 patients presented with severe liver function abnormality. The main types of lupus nephritis were Class 1V and Class V, 2 patients complicating with HBV-associated glomerulonephritis. Compared with the control group, patients with SLE complicating with HBV infection had a significantly higher prevalence of fever, liver involvement, renal lesion, thrombocytopenia and cytomegalovirus infection respectively. One patient with severe liver abnormality had poor prognosis. Conclusion More attention should he paid to the clinical features of SLE complicating with HBV infection. Patients with SLE complicating with HBV infection have a significantly higher prevalence of fever, liver involvement, renal lesion, thromhocytopenia and cytomegalovirus infection respectively. Patients with SLE complicating with HBV infection may suffer from HBV-associated glomerulonephritis. Severe liver abnormality predicts poor prognosis. Anti-HBV drugs should be prescribed for SLE patients with serological positive HBsAg while immunosuDpressive agents are used.