乙型肝炎病毒再激活及其预防性治疗.PDF

( ) 2017 2 11 1 Chin J Exp Clin Infect Dis (Electronic Edition), February 2017, Vol.11, No.1 · 4 · 中华实验和临床感染病杂志电子版 年 月第 卷第 期 · · 综述 乙型肝炎病毒再激活及其预防性治疗 1 2 1 1 【摘要】 全球约20亿人曾感染乙型肝炎病毒（HBV ），而任何损害免疫应答的因素均可能明显 改变HBV感染的状态，引发HBV感染再激活。再激活可表现为无症状，也可为暴发性肝炎、肝功能 衰竭甚至死亡。在不同危险因素下，HBV再激活率为24%～88%，病死率高于10%。HBV再激活的 危险因素包括使用生物制剂、糖皮质激素，基线高病毒载量以及HBV表面抗原阳性等。准备接受化 疗和免疫抑制剂治疗的患者均需进行HBV标志物筛查，并进行危险度分级，继而确定预防性治疗方 案，这对预防HBV再激活所致的危害具有重要意义。 【关键词】肝炎病毒，乙型；再激活；预防 Hepatitis B virus reactivation and prophylaxis Zhang Mengyang1 2 1 , Zhang Shuo , Zhou Baotong , 1 1 2 Liu Xiaoqing . Department of Infectious Diseases, Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing 100730, China Corresponding author: Liu Xiaoqing, Email: liuxqpumch@126.com Abstract It is estimated that two billion people have had hepatitis B virus (HBV) infection worldwide. 【 】 Any immunocompromised status will change the state of HBV infection and lead to HBV reactivation. The consequences of reactivation could be asymptomatic, fulminant hepatitis, hepatic failure and even death. The reactivation rate of HBV ranges from 24% to 88% with different risk factors, and the mortality rate is higher than 10%. The risk factors include the use of biological agents and glucocorticoids, high level of viral load at baseline, and positive HBV surface antigen, etc. All candidates for chemotherapy and immunosuppressive therapy should be screened for HBV infection, and receive risk classification and then prev