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目的:观察应用肿瘤坏死因子α(TNF-α)拮抗药治疗,是否导致非活动性乙型肝炎病毒(HBV)携带者病毒再活化。方法:总结分析47例在我院门诊和病房接受TNF-α拮抗药的无活动性病变的HBV携带者临床资料,所有患者在用药前HBsAg阳性,HBV-DNA低于检测下限(<5×10~2IU.mL~(-1)),天门冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)正常,治疗前及治疗后定期观察其肝功能、HBV-DNA、病毒血清学指标等。结果:2例非活动性HBV携带者在使用英夫利昔单抗治疗后出现HBV再活化,其中1例Crohn病患者在治疗开始22周准备第5次注射英夫利昔单抗前检查发现HBV再活化,另1例类风湿性关节炎患者在14周准备第4次注射英夫利昔单抗前检查发现HBV再活化。2例患者均给予拉米夫定抗病毒治疗,2月后复查,患者ALT、AST均恢复正常,HBV-DNA低于检测下限。结论:应用TNF-α拮抗药治疗肝功能正常、HBV-DNA低于检测下限的非活动性HBV携带者可能出现HBV再活化。
Objective: To observe whether the treatment with TNF-α antagonist could lead to reactivation of inactive HBV carriers. Methods: The clinical data of 47 cases of HBV carriers who had no active pathological changes in our clinic and ward receiving TNF-α antagonist were analyzed. All patients were positive for HBsAg and HBV-DNA was lower than the detection limit (<5 × 10 ~ 2IU.mL ~ (-1)), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were normal. Before and after treatment, their liver function, HBV-DNA, Indicators and so on. Results: In two inactive HBV carriers, HBV reactivation occurred after treatment with infliximab. One patient with Crohn’s disease was diagnosed before the fifth injection of infliximab 22 weeks after the start of treatment Activation, another case of rheumatoid arthritis patients at 14 weeks to prepare the fourth injection of infliximab before the test found that HBV reactivation. 2 patients were given lamivudine antiviral therapy, review after 2 months, patients with ALT, AST returned to normal, HBV-DNA below the detection limit. CONCLUSION: HBV reactivation may occur in inactive HBV carriers with HBV-DNA below the detection limit when TNF-α antagonists are used to treat normal liver function.