摘要:目的：糖皮质激素用于类风湿关节炎患者通常有使乙型肝炎复发活动的风险。该研究的目的是探究长期低剂量糖皮质激素治疗台湾类风湿关节炎患者的乙型肝炎病毒相关病死率的风险。

        方法：我们利用1999年1月到2011年12月全民健康保险研究资料库回顾性地分析了45423名类风湿关节炎患者，其中，有2204名患者诊断乙型肝炎并根据糖皮质激素治疗方法被分为4组，通过Cox模型分析对肝病相关病死率进行结果对比分析。

        结果：在队列中，90.5%的患者年龄大于40岁，105名患者采用短程大剂量糖皮质激素治疗(为A组)，862名患者采用糖皮质激素≥20mg/d≥3天或其他不同剂量但不超过C组剂量(为B组)，689名患者持续使用低剂量糖皮质激素(<20mg/d)持续时间≥3个月至少1疗程(为C组)，548名患者未曾使用糖皮质激素治疗(为D组)。261名患者采用抗病毒治疗，其中在C组使用人数明显高于其他组。有58名患者(2.63%)死于急性肝衰竭，其中各组无明显的统计学差异性(P=0.074)。C组和D组通过两样本检验比较发现长期小剂量糖皮质激素治疗与肝病相关死亡无相关性。

        结论：在类风湿关节炎合并乙型肝炎患者中长期低剂量糖皮质激素治疗与肝病相关病死率无相关性，可能与大多数患者采用抗病毒治疗有关。

        附原文：

        AbstRActPURPOSE: Glucocorticoids(GC) are commonly used in rheumatoid arthritis (RA) patients which bears a riskof hepatitis B virus (HBV) reactivation. The purpose of this study was toinvestigate the risk of HBV-related mortality under long-term low-dose GCs inTaiwanese RA patients.METHODS: We retrospectively analyzed 45,423 RA patientsusing National Health Insurance Research Database from January 1999 to December2011. Of them, 2204 patients had the diagnosis of HBV and were classified intofour groups according to GCs regimens. Outcome comparison by Cox model analysisfor liver-related mortality was performed.RESULTS: In this cohort, 90.5% wereolder than 40. One hundred and five patients had been treated with short-term large-doseGCs (Group A); 862 patients received GCs ≥20 mg/day for ≥3 days or a variable dose but did not meet Group C criteria (GroupB); 689 patients were continuously treated with low-dose (<20 mg/day) GCsfor ≥3 months for at least one session (Group C); and548 patients had never been exposed to GCs (Group D). Two hundred and sixty-onepatients had been exposed to antiviral agents, which was significantly higherin Group C. Fifty-eight patients (2.63%) died of acute hepatic failure, whileno statistically significant difference between each groups (p = 0.074). GroupsC and D comparison by two-sample test showed that long-term low-dose GCtreatment was not associated with liver-related death after adjusting formalignancy.CONCLUSION: Long-term low-dose GC treatment was not associated withliver-related mortality in RA with concomitant HBV patients probably due tocommonly applied antiviral therapy by rheumatologists.

        引自：Yang SS,Hung CT,Li SF，et al Hepatitis B virus-related mortality in rheumatoidarthritis patients undergoing long-term low-dose glucocorticoid treatment: Apopulation-based study.Journal of the Formosan Medical Association.2017