摘要： TNF-α拮抗剂越来越多的用于治疗免疫性疾病，例如类风湿关节炎、炎症性肠病和银屑病等。由于TNF-α是机体应对病毒感染的免疫反应的主要介质，合并HBV或HCV感染的患者应用TNF-α拮抗剂可能会导致病毒再活化，甚至导致致死性肝衰竭。

包涵领域：本研究综述了TNF对B型和C型病毒性肝炎的作用机制，HBV和HCV感染患者接受TNF拮抗剂治疗的推荐意见、安全性和TNF拮抗剂的肝毒性。

专家意见：HBsAg阳性的病毒携带者接受TNF拮抗剂治疗，应给予抗HBV治疗或者预防性治疗，以防止病毒复制。而HBsAg阴性抗HBc抗体阳性的患者只需要密切监测。相反的，HCV感染的患者，使用TNF抑制剂治疗是安全的，并可能有益，由于TNF-α通路参与HCV感染导致的肝脏炎症和纤维化过程。当患者需要进行抗病毒治疗或者病毒性肝炎复发时，HBV和HCV感染的患者需要接受肝病专家的专科治疗。

附原文：Abstract Introduction: Drugs targeting TNF-α biological activity are increasingly used for the treatment of immune-mediated diseases, like rheumatoid arthritis, inflammatory bowel diseases and psoriasis. Since TNF-α is a mediator of the immune response against viral infections, use of TNF-α inhibitors in patients with concurrent HBV or HCV infection can promote viral reactivation and potentially fatal liver failure. Areas covered: This paper reviews TNF mechanisms of action in viral hepatitis B and C, recommendations for managing HBV and HCV-infected patients receiving treatment with anti-TNF drugs, safety and anti-TNF hepatotoxicity. Expert opinion: In hepatitis B surface antigen (HBsAg) carriers undergoing anti-TNF therapy, either anti-HBV treatment or prophylaxis is mandatory to prevent hepatitis reactivation, whereas HBsAg-negative antibody to hepatitis B core antigen (anti-HBc) seropositive patients require watchful monitoring, only. Conversely, in HCV-infected patients, TNF-α inhibition by specific drugs is safe and could be even beneficial, as TNF-α pathways are involved in perpetuating liver inflammation and fibrosis progression in HCV. HBV- or HCV-infected patients should be referred to a hepatologist for expert clinical management whenever antiviral therapy is deemed necessary or hepatitis reactivation occurs.

引自：Viganò M, Degasperi E, Aghemo A, Lampertico P, Colombo M.Anti-TNF drugs in patients with hepatitis B or C virus infection: safety and clinical management. Expert Opin Biol Ther. 2011 Dec 22. [Epub ahead of print]