An examination of hepatitis B virus reactivation of neurootologic diseases treated with steroids
HBV-infected patients can suffer lethal consequences if HBV is reactivated through immunosuppressive medicine or chemotherapy and progresses to hepatitis B. We investigated HBV-related serum markers (HBs antigen, HBs antibody, HBc antibody) in patients with peripheral facial nerve paralysis and sudd...
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| Published in | jibi to rinsho Vol. 67; no. 6; pp. 367 - 374 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
JIBI TO RINSHO KAI
20.11.2021
耳鼻と臨床会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0447-7227 2185-1034 |
| DOI | 10.11334/jibi.67.6_367 |
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| Abstract | HBV-infected patients can suffer lethal consequences if HBV is reactivated through immunosuppressive medicine or chemotherapy and progresses to hepatitis B. We investigated HBV-related serum markers (HBs antigen, HBs antibody, HBc antibody) in patients with peripheral facial nerve paralysis and sudden deafness who received steroid therapies (total of 148 cases subjected to an HBs antigen analysis at the start of treatment). HBs antigen positivity was noted in none of the 148 cases (0 %); HBs antibody positivity was noted in 12 of 33 cases (36.4%), and HBc antibody positivity was noted in 7 of 25 cases (28.0%). No cases of reactivation of HBV or hepatitis B after steroid therapy were noted. Liver dysfunction developed in 2 of 8 patients (25.0%) who underwent regular post-treatment liver function testing. Forty-seven cases were treated with steroids for ≧ 2 weeks, and 101 were treated for < 2 weeks. Reactivation of HBV is thought to depend more on the duration of administration than on the dose of steroids, and the duration of treatment may need to exceed two weeks in order to ensure an adequate quantity of steroids has been administered for treatment. Therefore, when initiating steroid treatment, serum markers associated with HBV (HBs antigen, HBs antibody, HBc antibody) should be measured as an HBV screening analysis. |
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| AbstractList | HBV-infected patients can suffer lethal consequences if HBV is reactivated through immunosuppressive medicine or chemotherapy and progresses to hepatitis B. We investigated HBV-related serum markers (HBs antigen, HBs antibody, HBc antibody) in patients with peripheral facial nerve paralysis and sudden deafness who received steroid therapies (total of 148 cases subjected to an HBs antigen analysis at the start of treatment). HBs antigen positivity was noted in none of the 148 cases (0 %); HBs antibody positivity was noted in 12 of 33 cases (36.4%), and HBc antibody positivity was noted in 7 of 25 cases (28.0%). No cases of reactivation of HBV or hepatitis B after steroid therapy were noted. Liver dysfunction developed in 2 of 8 patients (25.0%) who underwent regular post-treatment liver function testing. Forty-seven cases were treated with steroids for ≧ 2 weeks, and 101 were treated for < 2 weeks. Reactivation of HBV is thought to depend more on the duration of administration than on the dose of steroids, and the duration of treatment may need to exceed two weeks in order to ensure an adequate quantity of steroids has been administered for treatment. Therefore, when initiating steroid treatment, serum markers associated with HBV (HBs antigen, HBs antibody, HBc antibody) should be measured as an HBV screening analysis.
B 型肝炎ウイルス（hepatitis B virus：HBV）既往感染者は、免疫抑制薬や化学療法によって HBV が再活性化することがあり、さらに肝炎を発症すれば、時に致死的となる。われわれは、ステロイド投与を行った末梢性顔面神経麻痺および突発性難聴症例（治療開始時に HBs 抗原検査を行った合計 148 例）に対して HBV に関するマーカーの検討を行った。 HBs 抗原陽性は、148 例中 0 例（0 ％）だった。HBs 抗体陽性例は、33 例中 12 例（36.4％）、HBc 抗体陽性例は 25 例中 7 例（28.0％）であ った。治療終了後 HBV 再活性化や肝炎発症例は認めなかったが、治療終了後に定期的に検査された症例 8 例中、肝機能の悪化症例が 2 例（25.0％）に見られた。ステロイドの投与期間が 2 週間以上の症例は 47 例（31.8％）、 2 週間未満は、101 例（68.2％）であった。HBV の再活性化はステロイドの投与量より投与期間に大きく依存するとされており、治療に十分な量のステロイドを投与するには、必然的に治療期間が 2 週間を超える可能性が想定される。そのため、ステロイド投与開始時は、HBV スクリーニングとして HBs 抗原、HBs 抗体、HBc 抗体の 3 項目とも測定するべきであると考えられた。 HBV-infected patients can suffer lethal consequences if HBV is reactivated through immunosuppressive medicine or chemotherapy and progresses to hepatitis B. We investigated HBV-related serum markers (HBs antigen, HBs antibody, HBc antibody) in patients with peripheral facial nerve paralysis and sudden deafness who received steroid therapies (total of 148 cases subjected to an HBs antigen analysis at the start of treatment). HBs antigen positivity was noted in none of the 148 cases (0 %); HBs antibody positivity was noted in 12 of 33 cases (36.4%), and HBc antibody positivity was noted in 7 of 25 cases (28.0%). No cases of reactivation of HBV or hepatitis B after steroid therapy were noted. Liver dysfunction developed in 2 of 8 patients (25.0%) who underwent regular post-treatment liver function testing. Forty-seven cases were treated with steroids for ≧ 2 weeks, and 101 were treated for < 2 weeks. Reactivation of HBV is thought to depend more on the duration of administration than on the dose of steroids, and the duration of treatment may need to exceed two weeks in order to ensure an adequate quantity of steroids has been administered for treatment. Therefore, when initiating steroid treatment, serum markers associated with HBV (HBs antigen, HBs antibody, HBc antibody) should be measured as an HBV screening analysis. |
| Author | UMENO, Yuta SAKATA, Toshifumi MAEHARA, Hiroki NISHI, Tatsuro SAWATSUBASHI, Motohiro |
| Author_FL | 澤津橋 基広 坂田 俊文 前原 宏基 梅野 悠太 西 龍郎 |
| Author_FL_xml | – sequence: 1 fullname: 前原 宏基 – sequence: 2 fullname: 澤津橋 基広 – sequence: 3 fullname: 梅野 悠太 – sequence: 4 fullname: 西 龍郎 – sequence: 5 fullname: 坂田 俊文 |
| Author_xml | – sequence: 1 fullname: UMENO, Yuta organization: Department of Otorhinolaryngology, Fukuoka University Chikushi Hospital – sequence: 1 fullname: SAKATA, Toshifumi organization: Department of Otorhinolaryngology, Fukuoka University Faculty of Medicine – sequence: 1 fullname: NISHI, Tatsuro organization: Department of Otorhinolaryngology, Fukuoka University Chikushi Hospital – sequence: 1 fullname: MAEHARA, Hiroki organization: Department of Otorhinolaryngology, Fukuoka University Chikushi Hospital – sequence: 1 fullname: SAWATSUBASHI, Motohiro organization: Department of Otorhinolaryngology, Fukuoka University Chikushi Hospital |
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| References | 1) 村上信五 ： 急性末梢性顔面神経麻痺に対する急性期の治療．顔面神経麻痺診療の手引き．55‒59 頁，金原出版，東京，2011 3) 坪内博仁 他 ： 免疫抑制・化学療法により発症する B 型肝炎対策 − 厚生労働省 「難治性の肝・胆道疾患に関する調査研究」 班劇症肝炎分科会および 「肝硬変を含めたウイルス性肝疾患の治療の標準化に関する研究」 班合同報告 −．肝臓 50 ： 35-42，2009 5) 小西正訓 ： ステロイド治療と HBV．Facial N Res Jpn 37 ： 112‒114，2017 4) 一般社団法人 日本耳鼻咽喉科学会 ： 突発性難聴、顔面神経麻痺等のステロイド治療における B 型肝炎ウイルス再活性化防止に関する指針．日耳鼻 122 ： 1551，2019 10) 一般社団法人 日本耳鼻咽喉科学会 ： 突発性難聴、顔面神経麻痺等のステロイド治療における B 型肝炎ウイルス再活性化防止に関する指針 （第 2 版）． http://www.jibika.or.jp/members/information/info_nanchou_2.html (2021.01.19 6) 田中義人 他 ： 急性感音難聴患者に対するステロイド加療による B 型肝炎増悪の有無の検討．日耳鼻感染症エアロゾル会誌 7 ： 79‒82，2019 2) 日本聴覚医学会 （編） ： CQ1-8 突発性難聴にステロイド剤の全身投与は有効か？ 急性感音難聴診療の手引き．57 頁，金原出版 , 東京，2018 7) Stennert E : Bell's palsy − A new concept of treatment −. Arch Otorhinolaryngol 225 : 265‒268, 1979. 9) 日本肝臓学会・肝炎診療ガイドライン作成委員会 ： 免疫抑制・化学療法により発症する B 型肝炎対策ガイドライン． https://www.jsh.or.jp/files/uploads/HBV_GL_ver3.3.pdf (2021.01.19 8) Egli Gallo D et al : Effectiveness of systemic high-dosedexamethasone therapy for idiopathic sudden sensorineural hearing loss. Audiol Neurootol 18 : 161-170, 2013. |
| References_xml | – reference: 9) 日本肝臓学会・肝炎診療ガイドライン作成委員会 ： 免疫抑制・化学療法により発症する B 型肝炎対策ガイドライン． https://www.jsh.or.jp/files/uploads/HBV_GL_ver3.3.pdf (2021.01.19) – reference: 2) 日本聴覚医学会 （編） ： CQ1-8 突発性難聴にステロイド剤の全身投与は有効か？ 急性感音難聴診療の手引き．57 頁，金原出版 , 東京，2018． – reference: 3) 坪内博仁 他 ： 免疫抑制・化学療法により発症する B 型肝炎対策 − 厚生労働省 「難治性の肝・胆道疾患に関する調査研究」 班劇症肝炎分科会および 「肝硬変を含めたウイルス性肝疾患の治療の標準化に関する研究」 班合同報告 −．肝臓 50 ： 35-42，2009． – reference: 10) 一般社団法人 日本耳鼻咽喉科学会 ： 突発性難聴、顔面神経麻痺等のステロイド治療における B 型肝炎ウイルス再活性化防止に関する指針 （第 2 版）． http://www.jibika.or.jp/members/information/info_nanchou_2.html (2021.01.19) – reference: 5) 小西正訓 ： ステロイド治療と HBV．Facial N Res Jpn 37 ： 112‒114，2017． – reference: 8) Egli Gallo D et al : Effectiveness of systemic high-dosedexamethasone therapy for idiopathic sudden sensorineural hearing loss. Audiol Neurootol 18 : 161-170, 2013. – reference: 1) 村上信五 ： 急性末梢性顔面神経麻痺に対する急性期の治療．顔面神経麻痺診療の手引き．55‒59 頁，金原出版，東京，2011． – reference: 4) 一般社団法人 日本耳鼻咽喉科学会 ： 突発性難聴、顔面神経麻痺等のステロイド治療における B 型肝炎ウイルス再活性化防止に関する指針．日耳鼻 122 ： 1551，2019． – reference: 6) 田中義人 他 ： 急性感音難聴患者に対するステロイド加療による B 型肝炎増悪の有無の検討．日耳鼻感染症エアロゾル会誌 7 ： 79‒82，2019． – reference: 7) Stennert E : Bell's palsy − A new concept of treatment −. Arch Otorhinolaryngol 225 : 265‒268, 1979. |
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| Title | An examination of hepatitis B virus reactivation of neurootologic diseases treated with steroids |
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