摘要
目的 探究抗结核药物对肺结核合并乙型肝炎(简称乙肝)患者肝功能及HBV-DNA水平的影响。方法回顾性分析2013年6月至2018年5月神木市医院及西安市胸科医院收治的83例肺结核合并乙肝患者的临床资料,按血清HBe Ag检测结果不同将患者分为HBe Ag阳性组(n=45)和HBe Ag阴性组(n=38),按血清HBV-DNA水平不同将患者分为高水平组(HBV-DNA≥103copies/ml,n=43)和低水平组(HBV-DNA <103copies/ml,n=40),分析肝损害发生率与HBV-DNA定量水平的相关性、肝损害程度与HBV-DNA定量水平的相关性,并记录肝损害出现时间及恢复时间。结果 HBV-DNA高水平组患者中的HBe Ag阳性及阴性的肝损害发生率分别为46. 5%、48. 9%,均分别高于低水平组中的12. 5%、11. 1%,差异具有统计学意义(P <0. 05);相同HBV-DNA水平患者的血清HBe Ag阳性和阴性的肝损害率比较,差异无统计学意义(P> 0. 05)。HBe Ag阴性组患者中,血清HBV-DNA高水平组的丙氨酸氨基转移酶(ALT)和总胆红素(TBL)分别为(108. 41±8. 32) U/L、(34. 51±5. 79)μmol/L,均分别高于其低水平组的(78. 36±7. 25) U/L、(22. 85±4. 25)μmol/L,差异具有统计学意义(P <0. 05)。HBV-DNA高水平组患者的HBe Ag阳性和阴性的肝损害时间分别为(15. 43±3. 96) d、(16. 38±4. 12) d,分别短于低水平组的(28. 35±4. 02) d、(32. 59±4. 36) d,差异具有统计学意义(P <0. 05);HBV-DNA高水平组的肝功能恢复时间分别为(83. 24±6. 38) d、(84. 25±7. 63) d,分别长于低水平组(61. 06±5. 92) d、(60. 39±6. 38) d,差异具有统计学意义(P <0. 05)。结论 对肺结核合并乙肝患者实施抗结核治疗会引起肝损害,且与HBV-DNA病毒载量密切相关,同时,HBe Ag阴性患者的血清HBV-DNA水平与肝功能指标呈正相关,此外,高水平病毒载量的肺结核患者肝损害发生时间早,且恢复时间长。
Objective To explore the effect of anti-tuberculosis drugs on liver function and HBV-DNA level in patients with pulmonary tuberculosis complicated with hepatitis B.Methods The clinical data of 83 patients with pulmonary tuberculosis and hepatitis B admitted to Shenmu Hospital and Xi'an Chest Hospital from June 2013 to May 2018 were retrospectively analyzed.Patients were divided into HBeAg-positive group according to the results of serum HBeAg test(n=45)and HBeAg-negative group(n=38).Patients were divided into high-level group(HBV-DNA≥103 copies/ml,n=43)and low-level group(HBV-DNA<103 copies/ml,n=40)according to different levels of serum HBV-DNA.The correlation between the incidence of liver damage and the quantitative level of HBV-DNA,the degree of liver damage and the quantitative level of HBV-DNA were analyzed,and the time and recovery time of liver damage were recorded.Results The incidence of HBeAg-positive and negative liver damage in patients with high HBV-DNA group was 46.5%and 48.9%,respectively,which were higher than 12.5%and 11.1%in the low-level group,respectively,and the difference was statistically significant(P<0.05).There was no significant difference in serum HBeAg-positive and negative liver injury rates between patients with the same HBV-DNA level(P>0.05).In the HBeAg-negative group,alanine aminotransferase(ALT)and total bilirubin(TBL)in the serum HBV-DNA high-level group were(108.41±8.32)U/L,respectively(34.51±5.79)μmol/L,which were higher than(78.36±7.25)U/L and(22.85±4.25)μmol/L in the low-level group,respectively,and the difference was statistically significant(P<0.05).HBeAg-positive and negative liver injury time in patients with high HBV-DNA group were(15.43±3.96)and(16.38±4.12)d,respectively,which were shorter than those in the low-level group,(28.35±4.02)d and(32.59±4.36)d.The difference was statistically significant(P<0.05).The recovery time of liver function in the high level of HBV-DNA were(83.24±6.38)d and(84.25±7.63)d,respectively,which were longer than those in the low level group,(61.06±5.92)d,60.39±6.38)d,the difference was statistically significant(P<0.05).Conclusion Anti-tuberculosis treatment in patients with pulmonary tuberculosis complicated with hepatitis B will cause liver damage,and it is closely related to HBV-DNA viral load.Meanwhile,serum HBV-DNA level in patients with negative HBeAg is positively correlated with liver function indicators.In addition,patients with high viral load of pulmonary tuberculosis have an early onset of liver damage and a long recovery time.
作者
高敏
宋晓燕
GAO Min;SONG Xiao-yan(Department of Infection,Shenmu Hospital,Yulin Shaanxi 719300,China;Department of Tuberculosis Medicine,Xi'an Chest Hospital,Xi'an Shaanxi 710100,China)
出处
《临床和实验医学杂志》
2019年第24期2652-2655,共4页
Journal of Clinical and Experimental Medicine
基金
陕西省卫生厅科研基金项目(编号:2016JM6029)
关键词
肺结核
乙型肝炎
抗结核药物
肝功能
HBV-DNA
Tuberculosis
Hepatitis B patients
Anti-tuberculosis drugs
Liver function
HBV-DNA
