抗结核治疗导致乙型肝炎病毒再激活相关性研究

目的 研究结核病合并HBV感染者抗结核治疗后肝功能、HBV-DNA载量水平及外周血T淋巴细胞亚群水平变化,探讨抗结核药物导致HBV再激活机率、可能发病机制及预防使用抗病毒药物的疗效.方法 选取南通市第六人民医院2018年1月-2021年1月在结核科诊治的结核病合并非活动性HBV感染者97例,随机分为预防性抗病毒治疗组(...

Correlation study of hepatitis B virus reactivated during antituberculous therapy

Objective To study the changes of liver function, HBV-DNA load and T lymphocyte subsets in peripheral blood after anti-tuberculosis treatment in patients with tuberculosis complicated with HBV, and to explore the possible pathogenesis of the probability of HBV reactivation caused by anti-tuberculosis drugs and the efficacy of antiviral drugs for prevention. Methods A total of 97 patients with tuberculosis complicated with inactive HBV who were treated in the TB department of the Sixth People’s Hospital of Nantong City from January 2018 to January 2021 were selected. They were randomly divided into two groups: the prophylactic antiviral treatment group (treatment group) and the non-prophylactic antiviral treatment control group (control group). The same anti-tuberculosis treatment regimen was adopted to observe the changes of liver function, HBV-DNA, serological indicators of HBV, T lymphocyte subsets in peripheral blood after anti-tuberculosis treatment. Results HBV reactivation occurred in 1 of the 45 patients in the preventive antiviral treatment group after antituberculous treatment, and the reactivation rate was 2.22%,HBV reactivation occurred in 10 of the 52 patients in the control group after anti-tuberculosis treatment, the reactivation rate was 19.23%, the difference was statistically significant (P<0.05). HBeAg in 11 patients with HBV reactivation were all changed from negative to positive. Before anti-tuberculosis treatment, HBV-DNA load of all patients was <1×10³ copies/mL, and that of the preventive antiviral treatment group after HBV reactivation was 3.47×10³ copies/mL. The HBV-DNA load in the control group was (2.62±3.07)×10⁸ copies/mL. HBV-DNA load level in the control group was significantly higher than that in the treatment group (t=10.12,P<0.05). among them, liver injury occurred in 13 patients (28.89%) in the antiviral treatment group, the non-prophylactic antiviral treatment control group, 20 patients (38.46%) developed liver injury, and the incidence of liver injury in the two groups differed significantly (χ²=7.163,P<0.05). However, in the treatment group, liver injury as mainly mild at grade 1, whereas in the control group, more moderate to severe liver damage was observed at grade 2 or 3. In the treatment group, anti tuberculosis treatment was suspended in 3 patients (6.67%), in the control group, 8 patients (15.38%) needed to suspend anti TB treatment, which was significantly higher than that of the treatment group. After antituberculosis treatment, in patients with non-reactivation of HBV,CD3⁺ and CD4⁺ in peripheral blood decreased, CD8⁺ increased slightly, and CD4⁺/CD8⁺ decreased, which was more significant in the control group, but there was no significant difference between the two groups (P>0.05). In patients with HBV reactivation, CD3 ⁺ and CD4 ⁺ decreased more significantly and CD4⁺/CD8⁺ decreased significantly, which was statistically significant between the two groups (t =5.870,9.890,7.750,P<0.05). Conclusion sAntituberculosis treatment can lead to hepatitis B virus reactivated, and the mechanism of reactivation may be related to the inhibition of T lymphocyte function. Prophylactic antiviral therapy can effectively reduce the probability of reactivation, reduce the occurrence and severity of liver injury.