ARD:乙型肝炎感染缓解患者的平均糖皮质激素剂量及HBV再激活和肝炎发作的风险

2022-01-17 MedSci原创 MedSci原创

时间加权平均泼尼松剂量大于20mg/d的乙肝表面抗原阳性风湿性疾病患者将被归类为HBV再激活或肝炎复发的高风险人群。这些高危患者可能需要预防性抗HBV治疗。

     目标:糖皮质激素(皮质类固醇)仍然是风湿性疾病的主要治疗方法,但会导致HBV感染缓解的患者重新激活乙型肝炎病毒 (HBV)。需要风险评估和分层来指导这些患者在皮质类固醇治疗前的管理。

     方法:来自重庆医科大学附属第一医院的研究团队前瞻性地招募了乙型肝炎表面抗原阳性抗乙型肝炎核心状态的患者,他们使用或不使用皮质类固醇,并通过计算泼尼松的累积剂量和时间加权平均每日剂量来确定皮质类固醇的暴露量。主要研究结果是HBV再激活、肝炎发作或严重肝炎的复合时间。

     结果:在1303名参与者中,该队列使用的强的松累积剂量和时间加权平均剂量的中位数分别为 3000 mgIQR300-6750 mg)和15 mg/天(IQR10-20 mg/天)。在多变量分析中,累积剂量与原发事件呈倒V形关系,峰值出现在累积剂量达到1506 mg时(HR3.7295% CI1.96 -7.08)。时间加权平均剂量的四分位数与事件风险的单调增加独立相关(每四分位数增加的HR2.1595% CI1.56 -2.98),75%-100%的最高四分位数HR 达到49.4895% CI6.24 -392.48)。在时间加权平均剂量的最高四分位数(Q4>20 mg/天)中,主要结局的发生率为16.67/100人年。其他四分位数的主要结局发生率均低于每 100人年10 次。

     结论:时间加权平均泼尼松剂量大于20mg/d的患者将被归类为HBV再激活或肝炎复发的高风险人群。这些高危患者可能需要预防性抗HBV治疗 

出处:

Zhong Z, Liao W, Dai L, et al. Average corticosteroid dose and risk for HBV reactivation and hepatitis flare in patients with resolved hepatitis B infection. Annals of the Rheumatic Diseases Published Online First: 21 December 2021. doi: 10.1136/annrheumdis-2021-221650

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    2022-09-01 klivis
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    2022-12-23 xlysu
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    2022-05-07 ms2000001510085796

    有用

    0

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    2022-01-18 萌宝嘟嘟

    好东西,谢谢分享

    0

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