HBsAg阳性的类风湿关节炎患者接受雷公藤多苷治疗的乙肝病毒再激活的临床研究

Clinical study on hepatitis B virus reactivation in rheumatoid arthritis patients with positive HBsAg treated by tripterygium glycosides

目的:探讨对乙肝表面抗原(HBsAg)阳性的类风湿关节炎患者接受雷公藤多苷治疗的乙肝病毒(HBV)再激活的临床效果。方法:选择2015年6月至2017年4月医院收治的HBsAg阳性类风湿关节炎患者60例,根据随机分为两组,每组各30例。对照组给予雷公藤多苷治疗,观察组在此基础上预防性应用拉米夫定治疗。比较两组谷丙转氨酶(ALT)、谷草转氨酶(AST)、HBV病毒载量、HBV再激活情况。结果:观察组治疗4周、8周及12周后ALT、AST水平均低于对照组,差异具有统计学意义(P<0.05);观察组治疗不同时间点HBV病毒载量升高率低于对照组,HBV再激活较对照组更低,差异均具有统计学意义(P<0.05)。结论:对HBsAg阳性的类风湿关节炎患者行单纯雷公藤多苷治疗,较联合预防性应用拉米夫定抗HBV临床效果欠佳,且对肝功能损害较大,HBV病毒载量和HBV再激活数均升高。

Objective:To investigate the clinical effect of hepatitis B virus(HBV)reactivation in rheumatoid arthritis(RA)patients with positive surface antigen of hepatitis B(HBsAg)treated by tripterygium glycosides.Methods:60 RA patients with positive HBsAg admitted from June 2015 to April 2017 were divided into two groups by random number table,with 30 cases in each group.The control group was treated with tripterygium glycosides,while the treatment group was given lamivudine in anti-HBV therapy based on the treatment of the control group.The alanine transaminase(ALT),glutamic oxalacetic transaminase(AST),HBV viral load,HBV reactivation were compared between the two groups.Results:The levels of ALT and AST after treatment for 4,8,12 weeks in the treatment group were lower than those in the control group(P<0.05);The rise rate of HBV viral load in treatment group at different time was lower than that in control group,while the HBV reactivation rate in the treatment group was lower than that in the control group(P<0.05).Conclusion:As for RA patients with positive HBsAg,the curative effect of pure tripterygium glycosides in anti-HBV therapy is unfavorable than that of tripterygium glycosides combined with lamivudine,as the former leads to larger damage to hepatic function,higher increased HBV viral load and HBV reactivation amount.