【摘要】 目的:探讨不同HBV感染状态的活动期类风湿关节炎(RA)患者使用甲氨蝶呤(MTX)联合艾拉莫德(IGU)治疗的肝脏安全性。方法:纳入2019年7月至2020年12月在佛山市南海区人民医院风湿免疫科就诊的活动期RA患者，使用MTX联合IGU治疗，疼痛明显者加用非甾体类消炎药或小剂量激素，HBsAg阳性者均建议预防使用核苷(酸)类似物抗病毒治疗。检测基线、12周、24周的活动指标，肝功能及HBV-DNA载量等指标。结果:共47例患者完成24周随访并纳入统计，根据HBV感染状态分为HBV携带组(n=8)、既往HBV感染组(n=21)、无HBV感染组(n=18)。3组治疗后第12、24周的红细胞沉降率、C反应蛋白、类风湿因子水平呈下降趋势，但差异无统计学意义；治疗后共4例(8.5%)出现转氨酶升高1～3倍；HBV携带组2例患者拒绝预防性抗病毒治疗，分别于第12、24周出现HBV再激活。结论:MTX联合IGU治疗活动期RA患者存在一定肝损害风险，可引起转氨酶轻度升高，治疗前应常规进行HBV感染的血清学检查，及时发现HBV感染患者并于治疗前接受预防性抗病毒治疗以减少HBV再激活的发生。更多还原

【Abstract】 Objective: To explore the liver safety of methotrexate（MTX） combined with iguratimod（IGU） on active rheumatoid arthritis（RA） patients under different status of HBV infection. Methods: Patients with active RA were enrolled from July 2019 to December 2020. All were treated with MTX in combination with IGU for 24 weeks. Adding with non-steroidal anti-inflammatory drugs（NSAIDs） or small doses of corticosteroids was permitted if constant pain observed. HBsAg+RA patients were suggested to be treated with anti-virus therapy preventively. Inflammatory marks, liver function, and HBV-DNA load were evaluated at baseline, 12^th and 24^th week. Results:Forty-seven patients with active RA were enrolled. Patients with active RA were grouped according to serum HBV biomarkers, including carrying HBV group（HBsAg+,n=8）, past HBV infection group（HBsAg-but HBcAb or HBeAb+,n=21） and free of HBV infection group（HBsAg and HBcAb-,n=18）. Erythrocyte sedimentation rate, C-reactive protein and rheumatoid factor showed a decreasing trend in all the groups, but there was no significant difference among them. 8.5% of the above developed aminotransferases elevation. In the carrying HBV group, 2 patients who refused antiviral prophylaxis developed HBV reactivation without aminotransferases elevation in 12^th and 24^th weeks. Conclusion: MTX combined with IGU therapy may induce mild aminotransferases elevation, and transient HBV reactivation, usually without hepatitis in active RA patients. They should be screened for liver function and HBV biomarker before therapy. Those with HBV infection were recommended to be treated with antiviral prophylaxis and monitor liver function and HBV-DNA load regularly.更多还原