莫守崎　李依蓝　许百洁　李奕琏

【摘 要】目的：观察类风湿关节炎伴携带乙型肝炎病毒患者接受甲氨蝶呤联合羟氯喹治疗过程中肝脏的安全性情况，为临床治疗提供参考。方法：选取疾病活动度高且处于乙型肝炎病毒携带状态的成年类风湿关节炎患者作为研究对象，并按照乙型肝炎病毒携带量将其分为A组（异常）和B组（正常），均给予甲氨蝶呤联合羟氯喹及预防性抗病毒治疗，期间密切监测并比较2组患者的肝酶学及病毒携带量变化情况。结果：用药50周后，A组出现肝酶学异常及病毒携带量增加者1例，后改用恩替卡韦进行预防性抗病毒治疗，而原类风湿关节炎的治疗方案不变，1周后患者检查指标逐渐恢复；B组出现肝酶学异常者1例，但其乙型肝炎病毒携带量未见增加，后给予对症治疗后恢复正常。结论：预防性抗病毒药物联合甲氨蝶呤联合羟氯喹。难治性类风湿关节炎伴乙型肝炎病毒携带患者是相对有效且安全的用药方案。

【关键词】 关节炎，类风湿；乙型肝炎病毒；甲氨蝶呤；羟氯喹

doi：10.3969/j.issn.2095-4174.2016.01.004

Observation on the Liver Safety in the Treatment of Patients with Rheumatoid Arthritis and HBV

with Methotrexate Combining Hydroxychloroquine

MO Shou-qi，LI Yi-lan，XU Bai-jie，LI Yi-lian

【ABSTRACT】Objective：To observe the liver safety in the treatment of patients with rheumatoid arthritis and HBV with methotrexate combining Hydroxychloroquine to provide reference for clinical treatment.Methods：Adult patients with active rheumatoid arthritis and HBV were selected and divided into group A （abnormal） and group B （normal） according to the amount of HBV.Both groups were treated with methotrexate combined with hydroxychloroquine and prophylactic antiviral therapy.Changes of peptase and amount of HBV of the two groups were monitored and compared.Results：After 50 weeks of medication，abnormal peptase appeared in group A and amount of HBV increased in 1 case.Then entecavir were used for the preventive antiviral therapy，while the original treatment for rheumatoid arthritis was unchanged.After a week，the indexes of patients were gradually recovered.In group B，abnormal peptase appeared in 1 case，with no increase of the amount of HBV，which was recovered after giving symptomatic treatment.Conclusion：Methotrexate combining Hydroxychloroquine is relatively safe and effective in the treatment of patients with rheumatoid arthritis and HBV.

【Keywords】 arthritis，rheumatoid；HBV；methotrexate；hydroxychloroquine

肿瘤坏死因子拮抗剂等生物制剂能够有效改善部分类风湿关节炎（rheumatoid arthritis，RA）患者的临床症状，但因其价格过于昂贵，导致临床应用受到较大限制。所以，RA的临床治疗方案仍以缓解病情抗风湿药的联用为主，甲氨蝶呤（MTX）联合羟氯喹（HCQ）是其中较成熟的联合方案之一[1-2]。但国内外对MTX联合HCQ治疗RA携带乙型肝炎病毒（HBV）患者的肝脏安全性研究较少。因此，本文拟通过严密监测MTX联合HCQ治疗RA合并HBV携带患者的病毒携带量、肝酶学变化及不良反应情况，以期增加对上述问题的