J Hepatology: 乙肝患者在接受糖皮质激素治疗后发生乙型肝炎表面抗原血清逆转的风险增加

2020-01-29 不详 MedSci原创

全身性皮质类固醇的使用可能引起HBV重新激活,但对先前接触过HBV的患者的影响尚不清楚。本项研究旨在探究先前接触过HBV的患者发生HBsAg逆转和肝炎发作的风险。

背景与目标
全身性皮质类固醇的使用可能引起HBV重新激活,但对先前接触过HBV的患者的影响尚不清楚。本项研究旨在探究先前接触过HBV的患者发生HBsAg逆转和肝炎发作的风险。

方法
研究人员纳入2001-2010年间HBsAg阴性并接受糖皮质激素治疗的患者。HBsAg(抗HBs)和/或HBcAg(抗HBc)抗体呈阳性的患者被定义为以前曾接触过HBV。主要观察终点为HBsAg血清逆转。次要终点是1年时出现肝炎发作(丙氨酸转氨酶> 80 U / L)。

结果
共有12997例患者符合纳入标准:仅抗HBs阳性(n = 10561);仅抗HBs阳性(n = 10561)。仅抗HBc阳性(n =970);抗HBs和抗HBc阳性(n = 830)和抗HBs和抗HBc阴性(n = 636)。165例患者发生了HBsAg血清逆转。抗HBc阳性的患者发生HBsAg血清逆转的风险更高(1年发生率1.8%),而抗HBs和抗HBc阴性的患者(0%;p= 0.014)。先前曾接触过HBV的患者与未接触过的个体相比,肝衰竭的风险也较低(1.1% VS 0.9%)。在每天峰值剂量为20–40 mg(调整后的危险比[HR] 2.19,p= 0.048)或> 40 mg(aHR 2.11,p= 0.015)的情况下,接受皮质类固醇激素治疗的患者发生肝炎发作的风险开始增加。泼尼松龙当量<7天,并在7–28天和> 28天的治疗时间增加(aHR 2.02–3.85;p < 0.001–0.012)。

结论
在仅抗HBc阳性的HBsAg阴性患者中,每天高剂量的皮质类固醇高剂量会增加发生肝炎发作的风险,而不会导致血清逆转。

原始出处:

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    2020-01-31 gwc384
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    2020-01-30 1478fa69m73暂无昵称

    学习了

    0

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