摘要:目的：糖皮質激素用於類風濕關節炎患者通常有使乙型肝炎複發活動的風險。該研究的目的是探究長期低劑量糖皮質激素治療台灣類風濕關節炎患者的乙型肝炎病毒相關病死率的風險。

方法：我們利用1999年1月到2011年12月全民健康保險研究資料庫回顧性地分析了45423名類風濕關節炎患者，其中，有2204名患者診斷乙型肝炎並根據糖皮質激素治療方法被分為4組，通過Cox模型分析對肝病相關病死率進行結果對比分析。

結果：在隊列中，90.5%的患者年齡大於40歲，105名患者采用短程大劑量糖皮質激素治療(為A組)，862名患者采用糖皮質激素≥20mg/d≥3天或其他不同劑量但不超過C組劑量(為B組)，689名患者持續使用低劑量糖皮質激素(<20mg/d)持續時間≥3個月至少1療程(為C組)，548名患者未曾使用糖皮質激素治療(為D組)。261名患者采用抗病毒治療，其中在C組使用人數明顯高於其他組。有58名患者(2.63%)死於急性肝衰竭，其中各組無明顯的統計學差異性(P=0.074)。C組和D組通過兩樣本檢驗比較發現長期小劑量糖皮質激素治療與肝病相關死亡無相關性。

結論：在類風濕關節炎合並乙型肝炎患者中長期低劑量糖皮質激素治療與肝病相關病死率無相關性，可能與大多數患者采用抗病毒治療有關。

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