TNF-α抑制剂治疗RA相关的乙肝再激活风险Meta分析

A Meta analysis of hepatitis B reactivation associated with tumor necrosis factor-αinhibitors in rheumatoid arthritis

目的:对使用肿瘤坏死因子抑制剂的乙肝感染相关的类风湿关节炎患者进行乙肝再激活风险的Meta分析。方法:对目标数据库进行检索,对符合要求的文献进行收集整理,确定纳入文献后提取相关的数据进行数据分析。结果:本研究共纳入14篇相关研究,涉及534例乙肝相关的类风湿关节炎患者,其整体综合乙肝再激活率为0.0175(95%CI:0.0054,0.0340),I^(2)=67%,P<0.01。在亚组分析中,使用糖皮质激素得到的乙肝再激活率为0.0676(95%CI:0.0396,0.1012),I^(2)=89%,P<0.01。未使用糖皮质激素得到的乙肝再激活率为0.0457(95%CI:0.0164,0.0846),I^(2)=69%,P<0.01。结论:乙肝感染相关的类风湿关节炎患者在使用肿瘤坏死因子抑制剂后具有一定的乙肝再激活率。在亚组分析中,目标人群的乙肝再激活率呈现出较为明显的地区分布,且使用糖皮质激素的亚组乙肝再激活率高于未使用糖皮质激素亚组。

Objective:To evaluate the possibility of hepatitis B reactivation in patients with hepatitis B infection-associated rheumatoid arthritis who were treated with TNF inhibitors.Methods:Literature search method and inclusion and exclusion criteria were established,then the databases were searched,literature meeting inclusion criteria were collected,and relevant data was extracted for analysis.Results:A total of 14 studies involving 534 HBV-related rheumatoid arthritis patients were included.The overall comprehensive hepatitis B reactivation rate was 0.0175[95%CI:0.0054,0.0340],I^(2)=67%,P<0.01.In the subgroup analysis,the reactivation rate of hepatitis B using glucocorticoids was 0.0676[95%CI:0.0396,0.1012],I^(2)=89%,P<0.01.The reactivation rate of hepatitis B without glucocorticoids was 0.0457[95%CI:0.0164,0.0846],I^(2)=69%,P<0.01.Conclusion:The employment of TNF inhibitors in patients with HBV-related rheumatoid arthritis had a certain rate of hepatitis B reactivation.In the subgroup analysis,the rate of hepatitis B reactivation in the target population showed a distinct regional distribution,and the rate of hepatitis B reactivation in the glucocorticoid-using subgroup was higher than that in the glucocorticoid-not subgroup.