肺结核合并HBsAg阳性患者抗结核治疗后乙肝病毒再激活的影响因素研究

目的分析抗结核药物引起肺结核合并HBsAg阳性患者乙肝病毒再激活的相关高危因素,进一步探讨恩替卡韦对抗结核治疗后乙肝病毒再激活的作用。方法回顾性分析肺结核合并HBsAg阳性患者在抗结核治疗后发生乙肝病毒再激活与年龄、性别、治疗前HBV-DNA载量、长期饮酒史、低蛋白血症及是否已使用恩替卡韦抗乙肝病毒治疗等因素的关系,并把有统计学意义的因素进行logistic回归分析。结果 72例肺结核合并HBsAg阳性患者,抗结核治疗后17例(23.61%)出现乙肝病毒再激活;经χ^(2)检验分析显示不同年龄、治疗前HBV-DNA载量、有无长期饮酒史、是否合并低蛋白血症、是否已使用恩替卡韦抗病毒等因素对出现乙肝病毒再激活差异有统计学意义(χ^(2)=7.522、14.421、11.466、4.303、7.810,P<0.05);logistic回归模型分析显示,治疗前HBV-DNA高载量和有长期饮酒史是肺结核合并HBsAg阳性患者抗结核治疗后乙肝病毒再激活的独立危险因素(OR=26.030,95%CI:2.402~282.115;OR=27.478,95%CI:1.777~424.891),而抗结核治疗前已使用恩替卡韦抗病毒是防治乙肝病毒再激活的保护性因素(OR=0.079,95%CI:0.008~0.830)。进一步分析治疗前已使用恩替卡韦抗病毒组抗结核期间出现乙肝病毒再激活率、肝功能损害率及被迫终止抗结核治疗率分别为8.82%、17.60%、8.82%,均明显低于未抗病毒组的36.80%、52.60%、42.10%(P<0.05)。结论 HBV-DNA高载量和有长期饮酒史是肺结核合并HBsAg阳性患者抗结核治疗后乙肝病毒再激活的独立危险因素,治疗前口服恩替卡韦可降低乙肝病毒再激活风险,减少肝脏不良事件发生。

Factors influencing hepatitis B virus reactivation after anti-tuberculosistreatment in tuberculosis patients with HBsAg positive

Objective To analyze the high risk factors of hepatitis B virus (HBV) reactivation caused by anti-tuberculosis drugs in tuberculosis patients with HBsAg positive, and to further explore the preventive effect of entecavir on HBV reactivation after anti-tuberculosis treatment. Methods We retrospectively analyzed the relationship of factors such as age, sex, HBV-DNA load before treatment, history of long-term alcohol consumption, hypoalbuminemia and anti-HBV treatment of entecavir with HBV reactivation after anti-tuberculosis treatment in tuberculosis patients with HBsAg positive. And logistic regression analysis was performed on the factors with statistical significance. Results HBV reactivation occurred in 17 (23.61%) of 72 tuberculosis patients with HBsAg positive after anti-tuberculosis treatment. χ² test revealed that there were statistically significant differences in age, HBV-DNA load before treatment, history of long-term alcohol consumption, hypoalbuminemia and anti-HBV treatment of entecavir between having and having no HBV reactivation (χ²=7.522, χ²=14.421, χ²=11.466, χ²=4.303, χ²=7.810, all P<0.05). Logistic regression analysis displayed that high level of HBV-DNA before treatment and history of long-term alcoholconsumption were independent risk factors for HBV reactivation after anti-tuberculosis treatment in the tuberculosis patients with HBsAg positive (OR=26.030, 95%CI: 2.402-282.115; OR=27.478, 95%CI: 1.777-424.891), while use of entecavir before anti-tuberculosis treatment was a protective factor for preventing HBV reactivation (OR=0.079, 95%CI: 0.008-0.830). Further analysis showed that the rates of HBV reactivation, liver function damage and forced termination of anti-tuberculosis treatment in the antiviral group using entecavir before anti-tuberculosis treatment were all significantly lower than those in the non-antiviral group (8.82% vs. 36.80%, 17.60% vs. 52.60%, 8.82% vs. 42.10%, all P<0.05). Conclusion High level of HBV-DNA and history of long-term alcohol consumption are independent risk factors for HBV reactivation after anti-tuberculosis treatment in the tuberculosis patients with HBsAg positive. Oral entecavir before anti-tuberculosis treatment can decrease the risk of HBV reactivation and reduce the occurrence of liver function damage.