乙型肝炎表面抗原阳性对抗结核药物性肝损伤的影响

doi:10.3969/j.issn.1000-6621.2015.02.011

摘要/Abstract

摘要： 目的探讨乙型肝炎表面抗原（HBsAg）阳性对抗结核药物性肝损伤的影响。方法将2010年2月至2014年1月来我站就诊的肺结核患者190例作为研究对象，以HBsAg阴性患者82例作为对照组，以HBsAg阳性患者108例作为观察组，比较两组患者抗结核治疗后肝功能损伤情况及肝功能损伤程度。应用SPSS 19.0软件进行处理分析，计量资料用“x±s”表示，计量资料比较采用t检验，计数资料样本率的比较采用χ²检验，以P<0.05为差异有统计学意义。结果观察组经抗结核治疗后肝损伤率为30.56%(33/108)，显著高于对照组肝损伤率12.20%（10/82），差异有统计学意义（χ²=8.974，P<0.05）；观察组随乙型肝炎病毒（HBV）感染程度的加重（单阳、小三阳、大三阳）肝损伤率呈上升趋势，分别为15.52%（9/58）、35.48% (11/31)、68.42% (13/19)，小三阳患者肝损伤率与单阳比较，χ²=4.623，P<0.05；大三阳患者肝损伤率与单阳比较，χ²=1.963，P<0.05；大三阳患者肝损伤率与小三阳比较，χ²=5.120，P<0.05，差异均有统计学意义。观察组抗结核治疗后血丙氨酸转氨酶(ALT)、血清总胆红素(TBL)指标分别为（394.25±48.39）U/L、（91.83±19.02）μmol/L，显著大于对照组的（247.61±52.48）U/L、（48.15±12.91）μmol/L（t=19.946、18.828，P值均<0.01）。观察组肝损伤恢复时间为（28.09±15.32）d，显著大于对照组的（11.26±7.34）d，差异有统计学意义（t=10.004，P<0.01）。结论 HBsAg阳性患者抗结核药物性肝损伤程度显著高于HBsAg阴性患者，且随着HBV感染程度的加深，肝损伤也随之加重，提示HBsAg 阳性对抗结核药物性肝损伤有明显影响。

关键词: 结核, 肺/药物疗法, 抗结核药, 药物性肝损伤, 乙型肝炎表面抗原

Abstract: Objective To explore the effects of positive hepatitis B surface antigen (HBsAg) on liver injury caused by anti-tuberculosis (TB) drugs. Methods One hundred and eight patients with positive HBsAg out of 190 pulmonary TB cases visited the station from February 2010 to January 2014 were enrolled in the observation group, and the other 82 cases with negative HBsAg were in control group. The status of liver function damage and degree of damage after anti-TB treatment of the two groups were compared. SPSS 19.0 was used for data analysis. t test was applied in comparison of quantitative data and Chi-square test was used in the comparison of categorical variables．P<0.05 was considered statistically significant. Results The liver damage rate of observation group (30.56%, 33/108) was significantly higher than that of the control group (12.20%, 10/82), and the difference was statistically significant (χ²=8.974，P<0.05). The liver damage rates of observation group increased with the severing infection of hepatitis B virus (HBV)(singal positive; HBsAg, HBeAb, and HBcAb test positive; HBsAg, HBeAg, and HBcAb test positive), which were 15.52% (9/58), 35.48% (11/31) and 68.42% (13/19) respectively. The differences of the liver damage rates among different degree of HBV infection were significant (HBsAg, HBeAb, and HBcAb test positive vs single positive: χ²=4.623, P<0.05; HBsAg, HBeAg, and HBcAb test positive vs single positive: χ² =1.963, P<0.05; HBsAg, HBeAg, and HBcAb test positive vs HBsAg, HBeAb, and HBcAb test positive: χ²=5.120, P<0.05). The alanine aminotransferase (ALT) and total bilirubin (TBL) of observation group were (394.25±48.39)U/L and (91.83±19.02) μmol/L, which were significantly higher than those of the control group ((247.61±52.48) U/L and (48.15±12.91) μmol/L)(t=19.946,18.828, all P<0.01). The recovery time from liver damage of observation group (28.09±15.32) day was significantly longer than that of the control group (11.26±7.34) day (t=10.004, P<0.01). Conclusion The liver damage induced by anti-TB drugs of patients with positive HBsAg is significantly more serious than that of patients with negative HBsAg, and liver damage aggravates with the severing infection of HBV, so that positive HBsAg has obvious effects on liver damage induced by anti-TB drugs.

Key words: Tuberculosis, pulmonary/drug therapy, Antitubercular Agents, Drug-induced liver injury, Hepatitis B surface antigens

赖晓宇，黄培生，刘桂芬. 乙型肝炎表面抗原阳性对抗结核药物性肝损伤的影响[J]. 中国防痨杂志, 2015, 37(2): 173-177. doi: 10.3969/j.issn.1000-6621.2015.02.011

LAI Xiao-yu，HUANG Pei-sheng，LIU Gui-fen. Effects of positive hepatitis B surface antigen on liver injury induced by anti-tuberculosis drugs[J]. Chinese Journal of Antituberculosis, 2015, 37(2): 173-177. doi: 10.3969/j.issn.1000-6621.2015.02.011

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