评估乙型肝炎病毒（HBV）再激活的风险，并评估抗病毒预防（AVP）在接受抗风湿治疗的HBV感染不同状态的患者的有效性。我们搜索了科克伦图书馆,Medline,和EMBASE用于随机对照试验(RCTs)，准RCT,非RCT,队列研究，或病例系列研究，检查患者接受抗风湿治疗有或没有AVP的HBV再激活。我们估计不同患者组之间的HBV再激活率（HRR）及其95％置信区间（CI）（间接比较）。我们还计算了利率比率(RR)，率差异(RD)与其95%CIs，和AVP需要治疗的数量（NNT）（直接比较）。纳入了53个病例系列研究，包括2162名患者。所有患者的AVPRD为-0.13（95％CI-0.21至-0.05），-0.16（95％CI-0.26至-0.06）风湿性慢性HBV感染患者，但对于其他HBV感染状态的患者无统计学意义。拉米夫定（RD-0.10，95％CI-0.25至0.05）的有效性低于其他预防性抗病毒药物（RD-0.31，95％CI-0.52至-0.11）。HHR变化从55％到5％的HBV状态和治疗。有有限的证据表明，AVP是有效的预防HBV再激活的患者接受抗风湿治疗。有效性因患者HBV状态和抗病毒方案而异。风湿性HBV携带者可能从AVP更有益，和拉米夫定可能不如其他AVP方案。这项研究的发现需要在严格的随机对照试验中进行进一步的调查。
To estimate the risk of reactivation of hepatitis B virus (HBV) and evaluate the effectiveness of antiviral prophylaxis (AVP) in patients with different status of HBV infection undergoing antirheumatic therapies. We searched Cochrane Library, Medline, and EMBASE for randomized controlled trials (RCTs), quasi-RCTs, non-RCTs, cohort studies, or case series studies examining reactivation of HBV in patients undergoing antirheumatic therapy with or without AVP. We estimated the HBV reactivation rate (HRR) and its 95% confidence interval (CI) among different patient groups (indirect comparison). We also calculated rate ratio (RR), rate difference (RD) with their 95% CIs, and the number needed to treat (NNT) of AVP (direct comparison). Fifty-three case series studies with 2162 patients were included. The RD of AVP was - 0.13 (95% CI - 0.21 to - 0.05) for all patients, - 0.16 (95% CI - 0.26 to - 0.06) for rheumatic patients with chronic HBV infection, but not statistically significant for patients with other status of HBV infection. Lamivudine (RD - 0.10, 95% CI - 0.25 to 0.05) was less effective than other prophylactic antiviral drugs (RD - 0.31, 95% CI - 0.52 to - 0.11). The HHR varied from 55 to 5% by HBV status and treatment. There is limited evidence that AVP was effective for preventing reactivation of HBV in patients undergoing antirheumatic therapy. The effectiveness varies by patient HBV status and antiviral regimens. Rheumatic HBV carriers may be more beneficial from AVP, and lamivudine may be inferior to other AVP regimens. Findings in this study warrant further investigation in rigorous RCTs.
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