全身性紅斑狼瘡患者的乙型肝炎盛行率偏低但伴隨較高比率的肝衰竭與肝癌

Prevalence of hepatitis B infection is lower in patients with systemic lupus erythematosus but is associated with a high risk of hepatic failure and hepatocellular carcinoma

目的：對於患有乙型肝炎之全身性紅斑狼瘡患者，病毒的重新活化一直是令人擔憂的問題。然而，目前對於全身性紅斑性狼瘡患者的乙型肝炎盛行率及預後資料仍相當缺乏。本研究試圖釐清全身性紅斑性狼瘡患者的乙型肝炎盛行率及預後。方法：在此回溯性世代研究中，我們回顧西元2011年至2013年間曾於國立台灣大學附設醫院住院之全身性紅斑狼瘡患者的病歷。收集其性別、年齡、病程、用藥紀錄與肝炎病毒相關預後包含肝炎、肝硬化及肝癌等資料以進行統計分析。結果：本研究總共收集268位全身性紅斑狼瘡患者。其中有22位病人的乙型肝炎表面抗原呈陽性。因此，乙型肝炎感染的盛行率為8.2%。與乙型肝炎表面抗原陰性的病人相比，陽性病人之肝衰竭風險比值為105.12，肝臟相關死亡風險比值為46.97，以及肝細胞癌風險比值為24.37；此三項風險比值皆上升且在統計學上達到顯著差異。針對感染乙型肝炎的病人做進一步分析，發現發生肝衰竭的病人平常使用的類固醇劑量高於未發生肝衰竭者，其在統計學上達到顯著差異。結論：在台灣，全身性紅斑狼瘡患者的乙型肝炎盛行率較一般族群低；但卻伴隨較高風險的肝衰竭與肝癌。其中，使用較高劑量的類固醇是其危險因子。因此，在使用免疫抑制劑治療全身性紅斑狼瘡患者時，也需謹慎評估其肝炎的狀況。

Objective: In patients with concomitant systemic lupus erythematosus (SLE) and hepatitis B virus (HBV) infection, HBV reactivation is a persisting concern. However, data regarding the prevalence and clinical outcomes of HBV infection in patients with SLE remains limited. Our study aimed to clarify the prevalence and prognosis of HBV infection in SLE patients. Methods: In this retrospective cohort study, we reviewed the medical records of SLE patients admitted in 2011–2013 to the National Taiwan University Hospital. Age, gender, disease duration, medication history, and hepatitis B virus-related outcomes—such as hepatitis, cirrhosis, and hepatocellular carcinoma—were documented for statistical analyses. Results: A total 268 patients with SLE were included in the study. Of these, 22 patients were HBs-Agpositive, and the prevalence of HBV infection was 8.2%. As compared to the HBs-Ag-negative group, the hazard ratios (HRs) of hepatic failure (HR = 105.12; p<0.0001), liver-related mortality (HR = 46.97 p=0.0006), and hepatocellular carcinoma (HR = 24.37; p=0.0094) were significantly higher in the HBs-Agpositive patients. The mean prednisolone dose was 12.50 (7.50–17.50) mg/day in the hepatic failure group and 5.00 (0.50–10.00) mg/day in the non-hepatic failure group; this difference in the prednisolone dose was significant (p=0.0106). Conclusions: The prevalence of HBV infection in SLE patients was lower than that in the general population in Taiwan; however, hepatitis B infection in SLE patients was associated with a high risk of poor hepatic outcomes, such as hepatic failure and hepatocellular carcinoma. The risk of hepatic failure increased when SLE patients with HBV infection received steroids at a dose higher than low dose regimens. Hepatitis status in SLE patients should therefore be closely monitored.