慢性B肝感染之風濕免疫患者接受莫須瘤（Rituximab）的前瞻性世代研究

A Prospective Cohort Study of Patients with Chronic Hepatitis B (HBV) Infection with Rheumatic Diseases Receiving Rituximab

目的：了解慢性B肝感染之風濕免疫疾病患者於接受莫須瘤後的臨床預後。方法：我們收集了從2019/07/01至2019/12/31住院接受莫須瘤之慢性B肝感染風濕免疫疾病患者，按照納入研究時是否使用抗病毒藥物分成使用藥物及無使用藥物組別，將急性肝炎發作作為主要療效指標。每位病人皆在追蹤210天後進行分析。結果：在納入收案的基礎資料當中，兩組除了B型肝炎核心抗體於無使用藥物組較高之外，並無統計顯著性差異。在180天時有兩位病人發生急性肝炎發作，發生率分別為在無使用藥物組為40.0%及使用藥物組為0%，由於樣本數較少因此無法達到統計顯著性。我們亦從B型肝炎核心抗體對於急性肝炎發作的ROC曲線中，發現作為預測急性肝炎發作的指標的可能性。結論：慢性B肝感染之風濕免疫患者在接受莫須瘤治療後，有較高的急性肝炎發作機會，而服用核酸類口服抗病毒藥物可有效降低發生率。

infection and rheumatic diseases receiving rituximab. Methods: We recruited patients with chronic HBV infection and rheumatic diseases admitted and placed on rituximab from July 1, 2019, to December 31, 2019. The patients were divided into antiviral-receiving and nonantiviral-receiving groups according to their baseline medications. The primary endpoint was set as acute hepatitis flare. After a 210-day follow-up period, we assessed the differences in baseline characteristics and primary outcome between these two groups. Results: There was no significant difference in baseline characteristics between the antiviral-receiving and nonantiviral-receiving groups, except that hepatitis B core antibody (anti-HBc) levels were higher in nonantiviral-receiving group. Two flare events developed during the 210-day follow-up period. The flare rates were 40.0% and 0.0% in the nonantiviral-receiving and antiviral-receiving groups, respectively, but the difference in flare rates was not significant due to the small sample size. The receiver operating characteristic (ROC) curve for anti-HBc levels provided the predictability of the flare. Conclusion: Patients with chronic HBV infection have a higher risk for hepatitis B flare and reactivation. Antiviral agents are effective in preventing flares.