小剂量来氟米特治疗类风湿性关节炎合并乙肝病毒携带者的疗效及安全性观察

Efficacy and Safety of Low-Does Leflunomide in Treatment of Rheumatoid Arthritis Concomitant Hepatitis B Virus Carriers

目的探讨小剂量来氟米特治疗类风湿性关节炎合并乙肝病毒(HBV)携带者的疗效和安全性。方法将115例确诊活动期类风湿性关节炎患者按乙肝患病情况分为3组,均给予来氟米特抗风湿治疗,观察疗效及HBV激活情况。结果治疗后各组患者的疾病活动性评分等疗效指标与治疗前相比皆有明显改善(P<0.05),有79.13%(91/115)患者疗效达ACR20;有15例(13.0%)患者治疗后出现肝功能异常,5例(4.3%)患者出现HBV再激活来自HBV携带者组,既往HBV感染组及无感染组患者治疗后均未出现HVB再激活;多元回归模型显示,使用来氟米特治疗的RA患者发生HBV再激活受基础乙肝患病情况、治疗前谷丙转氨酶(ALT)和关节肿胀数(SJC28)情况的影响,三者可使HBV再激活的风险增加约30%。结论来氟米特治疗类风湿性关节炎具有较好的临床疗效,但治疗前应检查肝脏疾病、肝功能及HBV-DNA载量,乙肝病毒携带者存在HBV再激活风险,应慎重选择。

Objective To study the efficacy and safety of low-does leflunomide in the treatment of rheumatoid arthritis concomitant hepatitis B virus carriers. Methods A total of 115 patients diagnosed with active rheumatoid arthritis were divided into 3 groups according to the infection condition of hepatitis B, and all received antirheumatic treatment with leflunomide. The efficacy and reactivation of hepatitis virus B （HBV） were investigated. Results Comparing to patients before treatment, a significant improvement of disease activity score 28 （ DAS 28 ） was observed in all groups after the treatment （P 〈0.05）, 79.13% （91/115） of patients achieved ACR 20 responses. There were 15 patients suffered from abnormal liver function （ 13.0% ） after treatment, 5 had HBV reactivation （4.3%） in HBV carriers group. Reactivation of HBV was not found in previous HBV infection group and infection-free group. Multiple regression model showed that the reactivation of HBV in RA patients treated with leflunomide was influenced by the basic infection condition of hepatitis B, alanine transaminase （ALT） level before treatment and swollen joint count （SJC28）. These 3 factors could increase the risk of HBV reactivation by 30%. Conclusion The leflunomide possesses better clinical efficacy for rheumatoid arthritis which should check liver disease, liver function and HBV-DNA load before treatment. As there has the risk of HBV reactivation in HBV carriers, leflunomide should be chosen carefully.