免疫抑制疗法相关的HBV再激活及其预防

摘要/Abstract

摘要： 乙型肝炎病毒再激活(HBVr)可导致肝功能衰竭,甚至死亡,从而加重疾病负担。近年来,与免疫抑制剂和免疫调节剂相关的HBVr及其预防和治疗已成为研究热点。新型免疫抑制剂和免疫调节剂的陆续研发并获批用于临床,为恶性肿瘤、风湿病等免疫介导的疾病提供了更加完善的治疗方案,极大提高了患者的生存率和生活质量。由于此类药物通过抑制机体免疫反应发挥疗效,在治疗原发病的同时增加了HBVr风险。因此,需要进一步评估各类免疫抑制剂和免疫调节剂的HBVr风险,并提前干预,避免不良事件发生。

关键词: 乙型肝炎病毒, 再激活, 免疫抑制剂, 核苷(酸)类似物

陈文雅, 赵红, 谢雯. 免疫抑制疗法相关的HBV再激活及其预防[J]. 肝脏, 2023, 28(3): 275-278.

参考文献

[1] 王贵强, 王福生, 庄辉, 等. 慢性乙型肝炎防治指南(2019年版). 肝脏, 2019, 24(12): 1335-1356.
[2] Lau G, Yu ML, Wong G, et al. APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy. Hepatol Int, 2021, 15(5): 1031-1048.
[3] Terrault NA, Lok ASF, McMahon BJ, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology, 2018, 67(4): 1560-1599.
[4] Chiu YM, Chen DY. Infection risk in patients undergoing treatment for inflammatory arthritis: non-biologics versus biologics. Expert Rev Clin Immunol, 2020, 16(2): 207-228.
[5] George VP, Vasileios L, Thodoris V, et al. Hepatitis B virus reactivation associated with new classes of immunosuppressants and immunomodulators: A systematic review, meta-analysis, and expert opinion. J Hepatol, 2022, 77(6): 1670-1689.
[6] Yoo S, Lee D, Shim JH, et al. Risk of Hepatitis B Virus Reactivation in Patients Treated With Immunotherapy for Anti-cancer Treatment. Clin Gastroenterol Hepatol, 2022, 20(4): 898-907.
[7] Ni Y, Gao LX, Lu Y, et al. Risk of HBV reactivation in relapsed or refractory diffuse large B-cell lymphoma patients receiving Bruton tyrosine kinase inhibitors therapy. Front Immunol, 2022, 13: 982346.
[8] Hoofnagle JH. Reactivation of hepatitis B. Hepatology,2009,49: S156-S165.
[9] Perrillo RP, Gish R, Falck-Ytter YT, et al. American Gastroenterological Association Institute technical review on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology, 2015, 148(1): 221-244.
[10] Harigai M, Winthrop K, Takeuchi T, et al. Evaluation of hepatitis B virus in clinical trials of baricitinib in rheumatoid arthritis. RMD Open, 2020, 6(1):e001095.
[11] Chen MH, Chen MH, Liu CY, et al. Hepatitis B Virus Reactivation in Rheumatoid Arthritis Patients Undergoing Biologics Treatment. J Infect Dis, 2017, 215(4): 566-573.
[12] Tokmak S, Gümürdülü Y, Tas DA, et al. What Is the Risk of Reactivation in Patients with Resolved and Past HBV Infection During Immunosuppressive Therapy If HBV-DNA Negative before Treatment? Turkish J Gastroenterol, 2021, 32(3): 294-301.
[13] Karaca M, Tural D, Akar E, et al. Hepatitis B Reactivation Rate Is Higher Undergoing Some Cytotoxic Chemotherapy in Patients with Solid Tumors: A Large Retrospective Study. Chemotherapy, 2018, 63(5): 247-252.
[14] Chen M, Zhuang J, Zhou D, et al. Outcome of anti-thymocyte immunoglobulin plus cyclosporine A for severe aplastic anaemia with chronic hepatitis B virus infection. Ann Hematol, 2017, 96(4): 581-587.
[15] Mikulska M, Nicolini L, Signori A, et al. Hepatitis B reactivation in HBsAg-negative/HBcAb-positive allogeneic haematopoietic stem cell transplant recipients: risk factors and outcome. Clin Microbiol Infect, 2014, 20(10): 694-701.
[16] Shiah HS, Chen CY, Dai CY, et al. Randomised clinical trial: comparison of two everolimus dosing schedules in patients with advanced hepatocellular carcinoma. Aliment Pharmacol Ther, 2013, 37(1): 62-73.
[17] Ogawa E, Wei MT, Nauyen MH, et al. Hepatitis B Virus Reactivation Potentiated by Biologics. Infect Dis Clin North Am, 2020, 34(2): 341-358.
[18] Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy, Gastroenterology. 2015, 148(1): 215-219.
[19] Smalls DJ, Kiger RE, Norris LB, et al. Hepatitis B Virus Reactivation: Risk Factors and Current Management Strategies. Pharmacotherapy, 2019, 39(12): 1190-1203.
[20] Yip TCF, Gill M, Wong GLH, et al. Management of hepatitis B virus reactivation due to treatment of COVID-19. Hepatol Int, 2022, 16(2): 257-268.