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Clinical Gastro H: 长期接受肿瘤坏死因子拮抗剂治疗的患者乙型肝炎病毒再激活和肝毒性的发生率

2018-12-09 MedSci MedSci原创

肿瘤坏死因子(TNF)拮抗剂是许多自身免疫疾病的一线治疗药物。然而,它们与乙型肝炎病毒(HBV)的再激活有关。研究人员测定了用抗TNF剂治疗自身免疫性疾病的患者的HBV再激活率和肝毒性发生率的情况。

背景与目的
肿瘤坏死因子(TNF)拮抗剂是许多自身免疫疾病的一线治疗药物。然而,它们与乙型肝炎病毒(HBV)的再激活有关。研究人员测定了用抗TNF剂治疗自身免疫性疾病的患者的HBV再激活率和肝毒性发生率的情况。

方法
研究人员回顾性收集了8887名成年患者从2001年到2010年使用TNF拮抗剂治疗自身免疫性疾病(皮肤病,风湿病或肠道)的临床数据。其中有HBV感染的占了52%。HBV再激活定义为以下1:HBV DNA> 1 log增加,先前为阴性时HBV DNA转为阳性,HBV DNA> 2000 IU / mL。肝毒性HT≥3根据国家癌症研究所常见毒性标准定义。我们进行了多变量逻辑回归以确定与HT≥3相关的因素。

结果
23名患者在基线时检测出HB表面抗原(HBsAg)阳性,其中9名患者HBV再激活;在基线时4267例HBV状态未知的患者中,2例HBV再激活。178例HBsAg阳性的乙型肝炎核心抗体(抗-HBc +)患者均无HBV再激活。HBV再激活发生在接受预防性抗病毒治疗的HBsAg +患者和未接受预防性抗病毒治疗患者中(P= .61)。273例患者(2.7%)发生HT≥3,但仅有3例归因于HBV。肝硬化与HT≥3显着相关(P<.001)。

结论
在对TNF拮抗剂治疗自身免疫性疾病的患者进行的回顾性分析中,研究人员发现39%的 HBsAg +患者出现了HBV再激活,但在治疗前HBsAg阴性和抗HBc +患者则没有出现HBV再激活。

原始出处:

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    2019-09-28 xlysu
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  5. 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target=_blank style='color:#2F92EE;'>#乙型肝炎病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23397, encryptionId=74672339e92, topicName=乙型肝炎病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Dec 11 13:01:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362924, encodeId=2d071362924b6, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Dec 11 13:01:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1485467, encodeId=412e148546eaf, content=<a href='/topic/show?id=3879828e19d' target=_blank style='color:#2F92EE;'>#肿瘤坏死因子#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82871, encryptionId=3879828e19d, topicName=肿瘤坏死因子)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43077999209, createdName=ms7524819409032184, createdTime=Tue Dec 11 13:01:00 CST 2018, time=2018-12-11, status=1, ipAttribution=)]
    2018-12-11 kafei

    学习学习谢谢

    0

  8. 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  9. 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target=_blank style='color:#2F92EE;'>#乙型肝炎病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23397, encryptionId=74672339e92, topicName=乙型肝炎病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Dec 11 13:01:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1362924, encodeId=2d071362924b6, content=<a href='/topic/show?id=b723414321c' target=_blank style='color:#2F92EE;'>#坏死#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=41432, encryptionId=b723414321c, topicName=坏死)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Dec 11 13:01:00 CST 2018, time=2018-12-11, status=1, ipAttribution=), 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    2018-12-11 millore
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此研究表明,五分一的人有肝脏失代偿或MELD大于15。19%的患者,疾病诊断被延迟;诊断测试不完整的占总数的三分之一。

Liver Int:慢性血液透析和肾移植患者中,隐匿性乙型肝炎病毒感染的流行率较低

研究发现,在CHD患者中,OBI的患病率为零,而KTxR患者OBI的流行率非常低(<1%),这表明在CHD人群中,不需要对HBV-DNA进行常规筛查。然而,在KTxR中,应考虑采用HBV-DNA进行移植前筛查。检测PBMCs中的HBV-DNA似乎没有额外价值。

J Hepatol:Sofosbuvir/velpatasvir治疗HCV基因1-4型肝移植患者,疗效显著且安全

SOF/VEL治疗HCV基因1-4型肝移植患者,疗效显著且安全。

J Hepatol:肝脏僵硬测量可检测出晚期肝纤维化,并可预测丙型肝炎相关事件

在初级保健卫生系统管理的CHC,由LSM所确定的晚期纤维化的流行率显著的,且与医院队列的流行率相当。此外,本研究支持将LSM作为CHC人群的社区筛选工具。

J Hepatol:社区保健中心CHC患者肝脏硬度增加的流行率和探究晚期肝脏疾病、肝脏相关事件的预测因素

在社区保健中心由LSM所确定的晚期纤维化的比率为16.5%,并且社区保健中心由LSM确定的肝硬化比率与医院队列相当。

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