使用免疫抑制剂的肾病患者抗乙肝的治疗分析

Analysis of Anti-hepatitis B Drug Treatment of Kidney Patients Using Immunosuppressants

目的调查分析广州市某医院长期使用免疫抑制剂治疗的患者对应用核苷类似物抗病毒的情况,以指导临床合理用药。方法收集2005～2010年间肾内科患有自身免疫性疾病和结缔组织疾病所致的肾损伤及肾移植术后合并HBV感染患者52例,A组33例使用免疫抑制剂同时服用核苷类似物,B组19例使用免疫抑制剂即已出现HBV再激活后,及时加用核苷类似物;并且分析病例资料、HBV-DNA水平和肝酶(ALT)及治疗期间用药情况。结果 A组中HBV再激活3例(9.1%),其中有2例重型肝炎,有1例肝硬化;B组HBV再激活3例(15.8%),其中3例肝硬化,无死亡病例。因此A组HBV发生率低于B组(P<0.05)。总体上讲,A组疗效优于B组。结论乙肝患者在使用免疫抑制剂前服用核苷类似物进行抗HBV治疗可有效降低HBV再激活概率。若已接受免疫抑制剂治疗,及时加用核苷类似物进行抗HBV治疗,仍可在很大程度上减少HBV再激活的概率。

patients in a Objective hospital in G To investigate the situation of the long-term usage of nucleoside analogues to antiviral from some uangzhou who used immunosuppressive therapy, so as to guide clinical application of drugs reasonably. Methods A total of 52 patients were collected in nephrology department, who had suffered from renal injury caused by autoimmune diseases and some connective tissue diseases and HBV co-infection after renal transplantation during 2005 -2010, 33 cases took immune inhibitors and nucleoside analogues in group A, 19 cases took immune inhibitor, who had appeared HBV reactivation, timely with nucleoside analogues in group B. Then the clinical data, HBV-DNA level, ALT and the usage of drugs during the treatment of those patients were analyzed. Results There were 3 HBV reactivations （9.1%） in group A, including 2 severe hepatitis, 1 liver cirrhosis. 3 HBV reactivations （15.8%） in group B, including 3 liver cirrhosis, no deaths. Therefore, the HBV incidence in group A was lower than that in group B （P 〈 O. 05 ）. The efficiency of group A was better than that of group B. Conclusion It can reduce the probability of HBV reactivation effectively if HBV patients use nucleoside analogues before using immunosuppressive agents in the anti HBV treatment. It can still reduce the probability of HBV reactivation greatly if patients had accepted immunosuppressive agents treatment, and timely add with nucleoside analogues treatment.