免疫抑制剂治疗过程中HBV再激活人群危险因素分析

Analysis of risk factors of hepatitis B virus reactivation during immunosuppressive therapy--A new model establishment

目的探讨免疫抑制剂或化疗药物治疗后HBsAg阳性或抗-HBc阳性人群发生HBV再激活(hepatitis B virus reactivation,HBVr)的危险因素。方法回顾性分析2010年1月至2017年1月上海市长海医院HBsAg阳性或HBsAg阴性而抗-HBc阳性238例患者的临床资料,接受免疫抑制剂治疗后,根据随访结果分为发生HBVr组与未发生HBVr组,分析HBVr发生的危险因素。结果238例患者中,发生HBVr的患者为33例(13.87%)。logistic回归模型提示:有无抗病毒治疗(OR=0.022,95%CI:0.001~0.34),HBV DNA基线水平(OR=15.352,95%CI:3.809~86.160),化疗方案(OR=0.361,95%CI:0.068~1.929),为发生HBVr的独立危险因素。根据变量筛选的结果,建立了预判HBVr风险的回归方程:-4.78×抗病毒干预(有=1,无=0)+2.731×HBV DNA(≥104=1,<104=0)+3.272×化疗方案(A=3,B=2,C=1)+3.355,以及相应的评分系统。结论HBVr的发生与有无抗病毒治疗、HBV DNA基线水平以及化疗方案的选择等因素有关,建立模型有助于对HBVr进行预测。

Objective To investigate the risk factors of hepatitis B virus reactivation(HBVr)in HBsAg positive or anti-HBc positive chronic hepatitis B(CHB)patients after treated with immunosuppressants or chemotherapy drugs.Methods HBsAg positive CHB patients and HBsAg negative but anti-HBc positive CHB patients who received immunosuppressive therapy were retrospectively analyzed,the number of the patients was 238.According to the follow-up results,they were divided into HBVr group and non-HBVr group.The risk factors of HBVr were analyzed.Results The average age of 238 patients was 49±14 years old,including 134 males(36.3%)and 33 HBVr patients(13.87%).Logistic regression model showed that there were significant differences between the two groups in whether received antiviral therapy(OR=0.022,95%Cl:0.001~0.34),(P<0.001),baseline level of HBV DNA(OR=15.352,95%Cl:3.809~86.160),(P<0.001)and chemotherapy regimen(OR=0.361,95%Cl:0.068~1.929),(P=0.023),which were independent risk factors of HBVr.According to the results of variable screening,the regression equation for predicting the risk of HBVr was established as follows:-4.78×antiviral intervention(yes=1,no=0)+2.731×HBV DNA(≥104=1,<104=0)+3.272×chemotherapy regimen(A=3,B=2,C=1)+3.355,and the corresponding scoring system was also established.Conclusion HBVr is related to whether patients received antiviral therapy,the baseline level of HBV DNA and the choice of chemotherapy regimen.The new model will be helpful in predicting the risk of HBVr.