摘要
目的分析HIV感染/AIDS并发结核病患者住院期间发生药物性肝损伤的临床特征及影响因素。方法回顾性收集成都市公共卫生临床医疗中心2017年收治的HIV感染/AIDS并发结核病的164例患者临床资料,包括性别、年龄、结核病类型、HIV感染途径、是否并发乙型或丙型病毒性肝炎、CD4^+T淋巴细胞计数、是否行艾滋病高效联合抗反转录病毒治疗、是否采用磺胺类药品治疗、是否使用抗真菌药品等。以抗结核药品治疗2周内是否发生药物性肝损伤分为肝损伤组(87例)和无肝损伤组(77例),对发生药物性肝损伤的影响因素进行分析。结果多因素logistic回归分析显示,CD4^+T淋巴细胞计数在200~<414个/μl、使用抗真菌药品是HIV感染/AIDS并发结核病患者在抗结核药品治疗中发生药物性肝损伤的独立危险因素(分别为Waldχ~2=6.769,P=0.009,OR(95%CI)=13.357(1.895~94.136);Waldχ~2=7.122,P=0.008,OR(95%CI)=2.834(1.319~6.089))。结论HIV感染/AIDS并发结核病患者进行抗结核药品治疗时,应警惕CD4^+T淋巴细胞计数在200~<414个/μl及使用抗真菌药品的患者发生药物性肝损伤的危险性,做到勤监测、早发现、早干预,必要时进行预防性护肝治疗。
Objective To investigate the clinical characteristics and risk factors of drug-induced liver injury in with hospitalized tuberculosis(TB)patients complicated with HIV/AIDS.Methods Clinical data of 164 TB patients complicated with HIV/AIDS co-infection from the Public Health Clinical Center of Chengdu in 2017 were retrospecively analyzed.The data included gender,age,type of TB,HIV-infected route,whether or not complicated with viral hepatitis B(HBV)and/or viral hepatitis C(HCV),count of CD4^+T cell,history of highly active anti-retroviral therapy(HAART),sulfonamides and antifungal treatment,etc.The patients were divided into liver injury group(n=87)and non-liver injury group(n=77)according to the occurrence of drug-induced liver injury within 2 weeks after anti-TB drug treatment,and the risk factors of drug-induced liver injury was analyzed.Results Multivariate logistic regression analysis showed that CD4^+T cell count between 200-<414 cells/μl and the use of antifungal drugs were independent risk factors for drug-induced liver injury in TB patients complicated with HIV/AIDS during anti-TB drug treatment(Waldχ^2=6.769,P=0.009,OR(95%CI)=13.357(1.895-94.136);Waldχ^2=7.122,P=0.008,OR(95%CI)=2.834(1.319-6.089)).Conclusion When treated with anti-TB drug,TB patients complicated with HIV/AIDS should be alert to the drug-induced liver injury if CD4^+T cell counts between 200 and 414 cells/μl and anti-fungal treatment.Frequent monitoring,early detection and early intervention should be conducted,and so as the preventive liver protection treatment if necessary.
作者
王艳
何畏
黄涛
吴桂辉
WANG Yan;HE Wei;HUANG Tao;WU Gui-hui(Department of Tuberculousis,Public Health Clinical Center of Chengdu,Chengdu 610061,China)
出处
《结核与肺部疾病杂志》
2020年第2期65-70,共6页
Journal of Tuberculosis and Lung Disease
基金
成都市科技惠民项目(2015-HM01-00479-SF)
关键词
HIV感染
获得性免疫缺陷综合征
结核
药物性肝损伤
危险因素
因素分析
统计学
HIV infections
Acquired immunodeficiency syndrome
Tuberculosis
Drug-induced liver injury DILI
Risk factors
Factor analysis,statistical
