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[Dr. Sinn's LiverTODAY 030 - Reactivation of hepatitis B]

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2018³â 9¿ù 17ÀÏ ¿ù¿ä¼ÒÈ­±âÁý´ãȸ¿¡¼­ ½Åµ¿Çö ±³¼ö´Ô²²¼­ Reactivation of hepatitis B¿¡ ´ëÇÏ¿© °­ÀÇÇØ Áּ̽À´Ï´Ù.


[FAQ]

[Áú¹®] ±Þ¼º BÇü °£¿°À» ¾ÎÀº ÈÄ HBsAg (-), HBcAb (+)ÀÎ »ç¶÷Àº °£¼¼Æ÷¿¡ HBV DNA°¡ integrationµÇ¾î ÀÖÁö ¾ÊÀ» °¡´É¼ºÀÌ ³ôÀ¸¹Ç·Î reactivation À§ÇèÀº ³·½À´Ï´Ù. ¸¸¼º BÇü °£¿°À» ¾Î´Ù°¡ HBsAg (-), HBcAb (+)ÀÎ »ç¶÷Àº °£¼¼Æ÷¿¡ HBV DNA°¡ integrationµÇ¾î ÀÖÀ» È®·üÀÌ ³ôÀ¸¹Ç·Î reactivation À§ÇèÀº ³ôÀ» °ÍÀÔ´Ï´Ù. ¹®Á¦´Â Àڱ⵵ ¸ð¸£°Ô HBcAb (+)°¡ µÈ »ç¶÷ÀÎ °Í °°½À´Ï´Ù. °Ô´Ù°¡ º¸Åë chemotherapy¿¡¼± HBsAg/sAb¸¸ °Ë»çÇÏ°í HBcAb´Â °Ë»çÇÏÁö´Â ¾Ê°í Àִµ¥... ÇâÈÄ ¸ðµç Ç×¾ÏÄ¡·á, ¸ðµç ¸é¿ª¾ïÁ¦Ä¡·á Àü¿¡ HBcAb¸¦ ²À ÃøÁ¤ÇØ¾ß ÇÒ±î¿ä?

[´äº¯] À§Ç輺Àº ³·¾Æ¼­ lymphoma ÀÌ¿Ü¿¡´Â Ç×¾ÏÄ¡·á Àü HBcAb¸¦ ÃøÁ¤ÇÏÁö´Â ¾Ê°í ÀÖ½À´Ï´Ù. (ÀÌÁØÇà ñÉ: lymphoma Ç×¾ÏÄ¡·á¿¡¼­´Â HbcIgG¸¦ ÃøÁ¤ÇÏ°í ÀÖ½À´Ï´Ù. ƯÈ÷ rituximab (a monoclonal CD20 antibody)À» »ç¿ëÇÒ ¶§¿¡´Â ±× À§Çèµµ°¡ »ó´çÈ÷ ³ô¾ÆÁý´Ï´Ù. Prophylatic treatment¸¦ ±ÇÇÏ°í ÀÖ½À´Ï´Ù)

[Áú¹®] Prophylaxis (HBcAb ¾ç¼ºÀ̸é Ä¡·á)¿Í pre-emptive (DNA°¡ ¾ç¼ºÀ̸é Ä¡·á)ÀÇ È¿°ú´Â ºñ½ÁÇÏ´Ù´Â Á¡°ú °£È¿¼Ò¼öÄ¡°¡ ³ô¾ÆÁø ÈÄ »ç¿ëÇÏ´Â on demand´Â È¿°ú°¡ ¾ø´Ù´Â °ÍÀº Àß ¾Ë°Ú½À´Ï´Ù. °£¼öÄ¡°¡ Á¤»óÄ¡¸¦ »ì¦ »óȸÇÏ´Â °æ¿ì ȤÀº Æò¼Òº¸´Ù 2¹è ³ô¾ÆÁø °æ¿ì Á¤µµ¿¡ Ç×¹ÙÀÌ·¯½º ¾àÁ¦¸¦ ¾²¸é ¾î¶»½À´Ï±î?

[´äº¯] ALT monitoring È¿°ú´Â ³·½À´Ï´Ù. DNA·Î monitoringÀ» ÇØ¾ß µµ¿òÀÌ µË´Ï´Ù. ¹®Á¦´Â DNA °Ë»ç °á°ú°¡ 1ÁÖÀÏ Á¤µµ °É¸®´Â °ÍÀÔ´Ï´Ù.

[Áú¹®] Pd 30mg 1´Þ Á¤µµ ¾²´Â °ÍÀº ¾î¶»½À´Ï±î?

[´äº¯] ÀúÀ§Ç豺ÀÔ´Ï´Ù.


[2019-11-28. Ãß°¡]

2019³â 11¿ù ¼ÒÈ­±âÇÐȸÁö¿¡ "¸é¿ª¾ïÁ¦ÀÚ¿¡¼­ ¸¸¼º BÇü°£¿°ÀÇ ¿¹¹æÀû Ä¡·á"¶ó´Â Á¦¸ñÀÇ Á¾¼³ÀÌ ½Ç·È½À´Ï´Ù.

PDF 1.3M

2018³â 9¿ù 17ÀÏ ¿ù¿ä¼ÒÈ­±âÁý´ãȸ¿¡¼­ ½Åµ¿Çö ±³¼ö´Ô²²¼­ °ü·ÃµÈ °­ÀǸ¦ ÇØ Á̴ּø ±â¾ïÀÌ ³³´Ï´Ù. HBsAg ¾ç¼º ȯÀÚ¿¡¼­ ¸é¿ª¾ïÁ¦Ä¡·á¸¦ ÇÒ ¶§ °£¼öÄ¡(ALT)·Î monitoringÇÏ´Â °ÍÀº È¿°ú°¡ ³·°í DNA·Î monitoring ÇØ¾ß ÇÑ´Ù´Â Á¡À» °­Á¶ÇØ Áּ̾ú½À´Ï´Ù. °£¼öÄ¡°¡ ¿À¸¥ ÈÄ Ç×¹ÙÀÌ·¯½º Ä¡·á¸¦ ÇÏ´õ¶óµµ º° È¿°ú°¡ ¾ø°í hepatic failure¿¡ ºüÁø´Ù´Â Á¡À» ¹è¿ü½À´Ï´Ù.


[2021-1-18. ÀÌÁØÇà]

¾È³çÇϽʴϱî. HBsAg (-)À̳ª HBcIgG positiveÀΠȯÀÚ¿¡¼­ ¾î¶² °æ¿ì¿¡ entecavir¸¦ ¹Ì¸® ½á¾ß ÇÏ´ÂÁö ´Ã Çò°¥·Á¼­... ´Ù½Ã Çѹø ½Åµ¿Çö ±³¼ö´Ô²² ¹®ÀÇÇÏ¿© ´äº¯À» ¹Þ¾Ò½À´Ï´Ù. Âü°íÇϽñ⠹ٶø´Ï´Ù.

¿äÄÁµ¥.... ¸é¿ª¾ïÁ¦ ÇÒ ¶§³ª Ç×¾ÏÄ¡·á ÇÒ ¶§¿¡´Â HBsAg À½¼ºÀ̶ó°í ¹æ½ÉÇÏÁö ¸»°í HB core antibody¸¦ È®ÀÎÇÏ¿© DNA±îÁö °Ë»ç¸¦ ÇÏ´øÁö Á¤±âÀûÀ¸·Î check ÇÏ´øÁö entecavir¸¦ ¹Ì¸® ¾²´øÁö Ç϶ó´Â °ÍÀÔ´Ï´Ù. ¹®ÀÇÇß´ø ȯÀÚ´Â Gastric lymphoma ȯÀÚ¿¡¼­ entecavir¸¦ Ç×¾ÏÄ¡·á ³¡³ª°í ³­ ÈÄ 1³â±îÁö ½á¾ß ÇÏ´Â °æ¿ì¿´½À´Ï´Ù. GI part¿¡¼­´Â ÁÖ·Î lymphoma³ª Å©·Ðº´À̳ª eosinophilic gastroenteriti¿¡ ÇØ´çÇÕ´Ï´Ù.

[2021-1-18. ½Åµ¿Çö ±³¼ö´Ô ´äº¯]

HBcIgG+ ÀÎ ºÐµéÀº HBsAg À½¼ºÀ̾ Rituximab »ç¿ë½Ã HBV °¡ reactivationÇÒ ¼ö ÀÖ½À´Ï´Ù. °ú°Å¿¡´Â monitoringÇÏ´Ù°¡ HBV reactivation½Ã Ä¡·áÇÏ¿´´Âµ¥, HBV reactivation½Ã ³Ê¹« fatalÇÑ °æ¿ìµéÀÌ ¸¹¾Æ¼­, entecavir µî Ç×¹ÙÀÌ·¯½ºÁ¦¸¦ prophylaxis¸ñÀûÀ¸·Î »ç¿ëÇÏ´Â °ÍÀ» ±Ç°íÇÏ´Â °¡À̵å¶óÀεéÀÌ ¸¹½À´Ï´Ù. 2019³â °³Á¤µÈ ¿ì¸®³ª¶ó °£ÇÐȸ °¡À̵å¶óÀÎÀÌ°í °ü·ÃµÈ ¹®±¸´Â ¾Æ·¡¿Í °°½À´Ï´Ù.

[Recommendations]

3. In HBsAg-negative, HBV DNA-undetectable, anti-HBc-positive patients, serum HBsAg and HBV DNA should be monitored during high-risk immunosuppression/chemotherapy and antiviral therapy started when HBV reactivation occurs. (A1) In particular, when a regimen includes rituximab, antiviral therapy can be initiated promptly at the start of immunosuppression or chemotherapy. (B1) 4. Prophylactic antiviral therapy should be maintained for at least 6 months after the termination of immunosuppression or chemotherapy and for at least 12 months after the termination of therapy if rituximab was included. (B1)

[2021-1-18. ÀÌÁØÇà Ãß°¡ Áú¹®]

2018³â °­ÀÇÇÏ½Ç ¶§ ´äº¯ ÁֽŠ³»¿ëÀ» Á¦°¡ ¸Þ¸ðÇØ µÐ ³»¿ëÀÔ´Ï´Ù. ±× Áß " À§Ç輺Àº ³·¾Æ¼­ lymphoma ÀÌ¿Ü¿¡´Â Ç×¾ÏÄ¡·á Àü HBcAb¸¦ ÃøÁ¤ÇÏÁö´Â ¾Ê°í ÀÖ½À´Ï´Ù." ºÎºÐ¿¡ ´ëÇÏ¿© Áú¹®µå¸³´Ï´Ù. ¾Ë·ÁÁֽŠ°¡À̵å¶óÀÎÀ» º¸´Ï immunosuppression Àü¿¡ anti-HBc¸¦ °Ë»çÇϵµ·Ï µÇ¾î ÀÖ¾ú´Âµ¥¿ä... Çö ½ÃÁ¡ÀÇ ´äº¯Àº ¾î¶°ÇÑÁö ±Ã±ÝÇÕ´Ï´Ù. lymphoma ÀÌ¿Ü¿¡µµ immunosuppression Àü¿¡´Â HbcAB °Ë»ç¸¦ ÇØ¾ß ÇÑ´Ù°í ±ÇÇÏ°í ÀÖ´ÂÁö¿ä?

[2021-1-18. ½Åµ¿Çö ±³¼ö´Ô Ãß°¡ ´äº¯]

ImmunosuppressionÀ̶ó´Â °ÍÀÌ intensity¿¡ µû¶ó HBV reactivation risk Â÷ÀÌ°¡ À־ ¸ðµç °æ¿ì¿¡ ±ÇÇÏÁø ¾Ê°í, intensity¸¦ °í·ÁÇÏ°í ÀÖ½À´Ï´Ù. ¾ÆÁ÷ ¸ðµç Àǻ簡 µ¿ÀÇÇÏ°í ÀÖÁö´Â ¾Ê½À´Ï´Ù¸¸; °£ÇÐȸ °¡À̵å¶óÀο¡¼­µµ risk¸¦ ¾Æ·¡¿Í °°ÀÌ ±â¼úÇÏ°í À־, high risk´Â ¹Ýµå½Ã ¿¹¹æÀû Ç×¹ÙÀÌ·¯½ºÁ¦ »ç¿ëÀ» ±Ç°íÇÏ°í ÀÖ°í, moderate´Â individulize, low risk´Â Å©°Ô ±ÇÇÏ°í ÀÖÁö ¾Ê½À´Ï´Ù.

´ëÇ¥ÀûÀÎ ÀÓ»ó »óȲÀ¸·Î´Â

1) ¸²ÇÁÁ¾ - ´ëºÎºÐ rituximabÀÌ Æ÷ÇԵǹǷΠ¹Ýµå½Ã HBcIgG È®ÀÎ ¹× ¿¹¹æÀû Ç×¹ÙÀÌ·¯½ºÁ¦ »ç¿ë

2) Hematologic stem cell transplantation : ¸é¿ª¾ïÁ¦Á¦ À庹ÇÏ°Ô µÇ°í ½ºÅ×·ÎÀ̵嵵 °í¿ë·® »ç¿ëÇϹǷΠHbcIgGÈ®ÀÎ¹× ¿¹¹æÀû Ç×¹ÙÀÌ·¯½ºÁ¦ »ç¿ë

3) non-liver solid organ transplantation (kidney, lung, heart): HbcIgGÈ®ÀÎ¹× ¿¹¹æÀû Ç×¹ÙÀÌ·¯½ºÁ¦ »ç¿ëÇÏ´Â Ãß¼¼

4) ±âŸ ¾ÏÁ¾ systemic chemotherapy - ¾Æ·¡ Ç¥ Âü°íÇؼ­ °áÁ¤Çϴµ¥, chemotherapy intensityºÁ¼­ °£È¤ Çϱ⵵ Çϴµ¥, ÀϹÝÀûÀ¸·Î´Â Àß ÇÏÁö ¾Ê½À´Ï´Ù. ´ëÇ¥ÀûÀ¸·Î ÈÄ À§¾Ï/´ëÀå¾Ï ÈÄ º¸Á¶Ç×¾ÏÄ¡·á¶§´Â low risk°¡ µÇ´Â °æ¿ì°¡ ¸¹¾Æ HBcIgG È®ÀÎ ¹× Ç×¹ÙÀÌ·¯½ºÁ¦ »ç¿ë Àß ¾ÈÇÏ°í ÀÖ½À´Ï´Ù.


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

© ¼º±Õ°ü´ëÇб³ ÀÇ°ú´ëÇÐ »ï¼º¼­¿ïº´¿ø ¼ÒÈ­±â³»°ú ½Åµ¿Çö (2018-9-17. ¿ù¿ä¼ÒÈ­±âÁý´ãȸ ¿Í ÀÌÈÄÀÇ º¸Ãæ)