短程化疗中乙肝病毒标志物阳性对肝功能影响及处理

目的 探讨抗结核治疗中乙肝病毒感染对肝功能的影响及其对策。方法 回顾性分析1746例肺结核病人及其中160例药物性肝损害的相关临床资料。结果176例乙型肝炎病毒标志物(HBVM)阳性结核病人中有68例(38.6%)出现肝损害,HBVM阴性患者1490例中出现肝损害70例(4.7%),另有80例未测HBVM者中22例(27.5%)出现肝损害。HBVM阳性与阴性的肝损害发生率差异极显著(P<0.01)。在治疗过程中出现肝损时间多为15～90d。结论 短程化疗中乙肝病毒感染对肝功能有一定的影响,在抗结核治疗前检查HBVM及肝功能十分必要,对HBVM阳性者宜选择对肝脏损害较轻的药物,同时给予适当的护肝治疗,并密切监测肝功能的变化。     

抗结核化疗对乙肝病毒标志物阳性者肝功能损害及对策

目的　探讨乙肝病毒标志物 (HBVM)阳性肺结核患者抗结核治疗中肝功能的损害及对策。方法　回顾性分析本院 6 91例痰菌阳性的初治肺结核中 ,97例 HBVM阳性 (A组 )与 5 94例 HBVM阴性 (B组 )抗结核治疗时肝功能损害的发生率。结果　 6 91例中发生药物性肝损害 73例 ,占总病例数的 10 .5 6 % ,其中 A组发生肝损者4 4例 (发生率 4 5 .36 % ) ;B组肝损者 2 9例 (4.88% ) ,二者有显著性差异 (P<0 .0 1)。治疗方案中含有利福平 (RFP)的 5 4 6例中 ,6 8例发生肝损 (发生率为 12 .4 5 % ) ,含有利福喷汀 (RFT)的 14 5例中 ,5例发生肝损 (3.5 4 % ) ,两者比较 ,肝损发生率有显著性差异 (P<0 .0 1)。 HBVM阳性患者 ,治疗方案含有 RFP的 88例中 ,4 3例发生肝损 (发生率4 8.86 % ) ,HBVM阴性患者 ,治疗方案含有 RFP的 4 5 8例中 ,2 5例发生肝损 (5 .4 6 % )。二者比较有显著性差异 (P<0 .0 1)。HBVM阳性者使用含 RFT方案治疗的 9例中 ,仅 1例发生肝损 ,肝损发生率降低为 11.1%。HBVM阳性患者治疗方案中含 RFP者与含 RFT者比较 ,肝损发生率也有显著性差异 (P<0 .0 5 )。结论　抗结核治疗中 HBVM阳性患者发生肝损比率明显增加 ,损害程度也明显增高。含 RFP的抗结核方案引起的肝功能损害明显大于含 RFT的抗结核方案。建     

抗结核药所致的药物性肝病43例临床分析

目的总结抗结核药所致药物性肝病（DILD）的临床特点及其预防和治疗。方法根据服药史、临床表现、肝功能检查、影像学检查及药物性肝病诊断标准,对2001年1月至2008年11月间经抗结核治疗后出现的43例患者进行临床分析和讨论。结果192例患者中,43例肝功能异常,占22．4％。其中12例经护肝治疗后,肝功能恢复正常,继续原方案化疗,同时予护肝治疗,未再次出现肝损害,不必停抗结核药。有21例（占48．8％）病人更改方案,停抗结核药3例（占6．9％）。接受抗结核治疗192例患者中,乙型肝炎病毒标志物HBsAg阳性者18例,其中7例出现肝损害,占38．9％,HBsAg阳性者药物性肝损害高于阴性者（P〈0．01）;结论多种抗结核药可引起药物性肝病;联合用药可增加药物的毒性;HBsAg阳性者抗结核治疗中易出现肝损害;在抗结核治疗前应常规检查肝功能、HBsAg,在用药过程中应定期监测肝功能;早期发现药物性肝病,停用抗结核药物及进行相应治疗。     

HBVM阳性肺结核病人用利福喷丁或利福平治疗肝功能损害观察

目的 观察利福喷丁?利福平对HBVM 阳性肺结核病人肝功能的影响?方法 对HBVM 阳性和阴性肺结核病人分别用利福喷丁和利福平治疗,观察治疗前后肝功能损害情况?结果 利福平组较利福喷丁组出现肝损害多( P< 0-01) ;HBVM 阳性较阴性病人易出现肝损害( P< 0-01) ;利福平组HBVM 阳性较阴性病人出现肝损害多( P< 0-01) ;利福喷丁组HBVM 阳性和阴性肝损害发生率无显著差异( P> 0-05) ?结论 抗结核治疗时HBVM 阳性比阴性病人更易发生肝损害,与其用药前即存在肝病理损害有关,治疗肺结核用利福喷丁比利福平疗效好且安全?     

HBVM阳性肺结核患者HBVDNA检测的临床意义

目的探讨HBVDNA（乙型肝炎病毒DNA）、HBVM（乙型肝炎病毒标志物）阳性肺结核患者抗结核治疗时对肝损害的影响。方法肺结核患者HBVM阳性且HBVDNA阳性为观察组A，HB．VM阳性、HBVDNA阴性者为观察组B，HBVM阴性为对照组C，观察各组抗结核药物肝损害发生率、停药率及A组HBVDNA水平与肝损害发生率、停药率有无相关。结果各组肝损害发生率两两比较均有显著性差异（P〈0．01）；A组停药率与其他两组均有显著性差异（P〈0．01），B组与C组无显著性差异（P〉0．05）；A组HBVDNA水平与肝损害发生率、停药率无相关（P〉0．05）。结论HBVM阳性尤其HBVDNA阳性肺结核化疗应重视，HBVDNA阴性者可短程化疗，HBVDNA阳性者都应慎行短程化疗。     

抗结核药物对乙肝病毒标记物阳性合并结核患者的肝功能影响

目的 观察分析220例抗结核药物对结核合并乙肝病毒标记物(HBVM)阳性患者肝功能的影响及肝损害与乙肝病毒载量水平(HBVDNA水平)的相关性.方法 88例HBVM阳性而HBVDNA阴性患者(Ⅰ组);132例HBVM阳性且HBVDNA阳性患者(Ⅱ组);与同期住院686例HBVM阴性患者作对照(Ⅲ组).HBVDNA阳性患者根据HBVDNA水平:在300拷贝/mL～ 105拷贝/mL之间的患者(Ⅱa组);HBVDNA水平﹥105拷贝/mL的患者(Ⅱb组).结果 肝损害发生率分别为:Ⅰ组10例(11.36%);Ⅱ组58例(43.94%);Ⅲ组84例(12.24%);Ⅱ组与Ⅰ组、Ⅲ组之间经统计学处理均有显著性差异,而Ⅰ组与Ⅲ组之间无明显差异;Ⅱa组18例(31.58%);Ⅱb组40例(53.33%),经统计学处理有显著性差异(P<0.05).结论 HBVM阳性而HBVDNA阴性合并结核的患者可予有效抗结核治疗,HBVM阳性且HBVDNA阳性患者在接受抗结核治疗时发生肝损害的危险性大,肝损害的危险性与HBVDNA水平成正相关.     

抗结核药物对肝功能影响及其对策

几十年来抗结核化疗对结核病疫情控制起了很大作用 ,但我国是乙型肝炎的高发区 ,乙肝病毒标志物阳性携带者相当普遍 ,携带率 10 %。同时 ,多数抗结核药物对肝脏有不同程度的损害 ,尤其是结核伴有乙肝病毒标志物 (HBVM)阳性的患者。在接受抗结核治疗中药物对肝功能的影响文献报道不一 ,因此 ,探讨抗结核治疗中出现肝损时的影响因素 ,现将我院收治的 174 5例肺结核患者中出现肝损的 161例 ,其中 HBVM阳性的 175例、阴性的 14 90例、以及未检 HBVM80例出现肝损者的情况作一探讨。1　资料与方法1994年～ 1999年 12月在我院收治的 174 5例肺…     

合并慢性乙型肝炎对抗痨治疗肺结核患者疗效的影响

目的观察分析不同乙型肝炎病毒载量的肺结核患者在抗结核治疗过程中肝功能的变化，了解乙型肝炎病毒对抗结核治疗的影响。方法79例HBV M阳性的肺结核患者，根据HBV DNA大于或小于1×10^5 copies／ml分为A、B组，与23例HBV M阴性肺结核患者比较在接受抗结核治疗时药物性肝炎和重型肝炎发生的情况。结果A组和B组肝功能异常出现和复常时间，及肝损害程度差异无统计学意义（P〉0．05），但均较HBV M阴性组肝功能异常出现时间早而复常时间较长，且肝损害程度明显重于阴性组（P〈0．05）；A组和B组药物性肝炎和重型肝炎发生率差异无统计学意义（P〉0．05），但均明显高于阴性组（P〈0．05）。结论对于HBV M阳性的肺结核患者，在化疗期间一定要密切监测肝功能情况，病毒载量指标不是引起肝功能异常的最直接原因，而只是其中的原因之一。     

继发型肺结核患者短程化疗致肝功能损害的临床分析

目的 了解继发型肺结核患者短程化疗引起肝功能损害情况。方法对我院2005年12月至2006年12月215例继发型肺结核患者在抗结核药物治疗中出现的肝损害情况进行临床分析。结果（1）继发型肺结核患者抗结核治疗前肝功能正常者184例，占85．6％；异常31例，占14．4％。治疗后肝功能正常者151例，占70．2％；异常64例，占29．8％。（2）抗结核治疗后出现肝功能异常时间：72．7％患者发生于治疗2周内，90．9％患者发生于治疗第1个月内。结论继发型肺结核患者抗癌治疗中易出现肝功能损害，加强护肝治疗，能保证肺结核病人化疗方案完成。     

化疗对继发型肺结核合并HBsAg阳性患者肝功能的影响

目的探讨继发型肺结核合并HBsAg（＋）患者抗结核治疗对肝功能的影响。方法 对201例继发型肺结核患者在抗结核药物治疗中出现的肝损害情况进行临床分析。结果继发型肺结核合并HBsAg（＋）患者31例，抗结核治疗后出现肝损害15例；HBsAg（-）患者170例，抗结核治疗后出现肝损害47例，两组差异有统计学意义（P〈0．05）。结论继发型肺结核合并HBsAg（＋）患者抗结核治疗后更容易出现肝功能异常。对合并HBsAg（＋）的肺结核患者治疗时，应密切监测肝功能。     

The impact of antituberculosis drugs upon liver function in patients with positive HBVM

Through the liver function analysis of 100 tuberculosis cases in the course of antituberculosis chemotherapy the authors found that the abnormal liver function rate turned to be 50% in the positive HBVM Group but only 2.4% in the negative, HBVM Group. There is a significant statistical difference between the two groups of cases (P less than 0.01). For this reason, the authors suggested the HBVM should be determined one by one before taking the antituberculosis chemotherapy in the area with high incidence of B-type hepatitis, the data indicated clearly that, the abnormal phenomena of liver function after the antituberculosis treatment for those patients, mainly caused by the drugs.     

抗结核组合药对HBVM阳性肺结核病人肝功能影响的观察

目的　观察抗结核组合药对HBVM阳性肺结核病人肝功能的影响。方法 比较HBVM阳性和阴性肺结核病人组合药治疗前后肝功能损害情况。结果 HBVM阳性病人肝损率比阴性者明显增高(P<0.01);其中“模式Ⅰ”与“模式Ⅱ”病人肝损率差异不显著(P>0.05),而“模式Ⅰ+Ⅱ”病人肝损率比“模式Ⅲ”高(P<0.05)。结论 组合药致肝功能损害,HBVM阳性病人比阴性多见,尤以“模式Ⅰ、Ⅱ”病人更易发生,可能与用药前肝脏病理损害严重程度有关。应慎用组合药并积极采取综合措施防范。     

初治肺结核住院病人发生肝损害的危险因素分析

目的调查广西初治肺结核住院病人抗结核治疗引起肝损害的情况。方法采用历史性队列研究,收集2007年5-10月符合纳入标准的病人的病例资料进行总结分析。结果781例病人有160例出现肝损害,发生率为20．49％,广西初治肺结核住院病人抗结核治疗引起肝损害的危险因素为男性、高龄、乙肝病毒携带者HBsAg（＋）、营养不良、嗜酒以及化疗时未使用护肝药物,其比值比与可信区间分别为0．423（0．232—0．770）、2．200（1．474—3．283）、2．174（1．340-3．527）、0．450（0．294-0．690）、2．085（1．511-2．878）、5．231（4．863—6．025）。结论通过危险因素的研究,有针对性采取有效预防和控制措施,以及在治疗同时加服护肝药,对降低抗结核药物所致肝损害的发生率具有重要的意义。     

Oxidative stress,antioxidant status and lipid profile in pulmonary tuberculosis patients before and after anti-tubercular therapy

BackgroundPulmonary tuberculosis (PTB) is a highly infectious dreadful disease caused by mycobacterium tuberculosis (MTB). Numerous studies reported free radicals activity, antioxidant status and lipid profile in PTB patients, but previous studies have lacunae in comparing the biochemical variables between before and after anti-tubercular therapy (ATT) supplementation to PTB patients. Hence, the present study was carried out to investigate oxidative stress markers, antioxidant status, lipid profile, liver function markers, and glycoprotein components in pulmonary tuberculosis patients (PTB) patients before and after 60 days of ATT.MethodsThis is a case-control study carried out with 100 healthy subjects and 110 PTB patients. All the patients diagnosed with sputum test and were positive for acid fast bacilli (AFB) were included for the study. An informed consent was obtained from all the patients.ResultsOur study found increased levels of oxidative stress markers, decreased enzymatic and non-enzymatic antioxidants, altered lipid profile in PTB patients as compared to healthy subjects before treatment and these levels were restored after clinical improvement with ATT. We also found increased concentrations of liver function parameters and components of glycoprotein in PTB patients. ATT refurbished lipid levels, antioxidant status and oxidative stress markers with decrease in liver function enzymes and glycoproteins in PTB patients.ConclusionCo-supplementation of antioxidants, along with ATT and inclusion of nutritious diet could be useful to reduce the pathogenesis of PTB and is warranted as a future study for the management of PTB.     

HBVM阳性肺结核患者HBVDNA检测的临床意义

目的探讨HBVDNA(乙型肝炎病毒DNA)、HBVM(乙型肝炎病毒标志物)阳性肺结核患者抗结核治疗时对肝损害的影响。方法肺结核患者HBVM阳性且HBVDNA阳性为观察组A,HB-VM阳性、HBVDNA阴性者为观察组B,HBVM阴性为对照组C,观察各组抗结核药物肝损害发生率、停药率及A组HBVDNA水平与肝损害发生率、停药率有无相关。结果各组肝损害发生率两两比较均有显著性差异(P<0.01);A组停药率与其他两组均有显著性差异(P<0.01),B组与C组无显著性差异(P>0.05);A组HBVDNA水平与肝损害发生率、停药率无相关(P>0.05)。结论HBVM阳性尤其HBVDNA阳性肺结核化疗应重视,HBVDNA阴性者可短程化疗,HBVDNA阳性者都应慎行短程化疗。     

利福平与异烟肼合用致肝损害的临床与病理分析

目的为探讨利福平与异烟肼合用致肝损害的临床表现与病理变化的关系。方法对１９４例应用利福平与异烟肼治疗的初治结核患者进行了临床与病理分析，其中２８例行经皮肝穿刺活组织检查（活检），另１７例行两次肝活检。结果５９例乙型肝炎病毒标志物（ＨＢＶＭ）阳性者，治疗后出现肝功能异常２１例（３５．６％），１３５例ＨＢＶＭ阴性者中１３例（９．７％）肝功能异常，两组比较Ｐ＜０．０１。且血清丙氨酸转氨酶（ＡＬＴ）的变化与肝脏病理损害程度大致成正比。当停用利福平和异烟肼或减量后，其ＡＬＴ与肝脏病理损害大多在６周以内恢复正常。利福平（Ｒ）与异烟肼（Ｈ）致肝病理损害与慢性乙型肝炎比较本质上无明显差别，但表现形式上有两点不同：汇管区炎症细胞不同，前者以嗜酸性粒细胞为主，后者以淋巴细胞为主；前者肝内胆汁淤积发生率较高。结论抗结核治疗时ＨＢＶＭ阳性者比阴性者更易发生肝损害，与其用药前即存在肝病理损害有关；ＲＨ与乙型肝炎病毒致肝损害的机理可能不同。     

Tuberculosis in the patients undergoing haemodialysis in Japan, 1996

We conducted a questionnaire survey on patients undergoing haemodialysis about the present situation of tuberculous incidence. They are immunocompromised hosts and are said to be at high risk of developing tuberculosis in many reports. (1) DESIGN Of the 167,192 patients on haemodialysis registered on December 31, 1996 in Japan, 71,411 patients were available for the questionnaire survey. Of the 2,893 hospitals used as the study subjects, 1,108 hospitals gave satisfactory replies. Of them, 141 hospitals reported that they had patients with tuberculosis in 1996, and 79 cases were collected by the detailed survey on tuberculosis patients conducted later. They included 45 male cases, 34 female cases for tuberculosis of all forms, 28 male cases, 15 female cases for pulmonary tuberculosis (PTB), 13 male cases, 4 female cases for tuberculosis bacilli positive pulmonary tuberculosis (TB positive PTB), and 17 male cases, 19 female cases for extrapulmonary tuberculosis. (2) RESULTS: In tuberculosis of all forms, the number of observed patients (O) against the number of patients expected (E) was calculated, and the standardized patients ratio (O/E ratio) was computed. It was 1.55 for male, 2.79 for female and 1.99 for total. The incidence of tuberculosis haemodialysis patients was significantly higher compared with the general population (p < 0.01). As to PTB, the O/E ratio was 1.01 for male, 1.40 for female and 1.16 for total; the incidence of PTB was not significantly higher compared with the general population. With TB positive PTB, the O/E ratio was 0.96 for male, 0.80 for female and 0.97 for total, and no significant difference was found. As for extrapulmonary tuberculosis, the O/E ratio was 13.45 for male, 13.07 for female and 12.97 for total; the incidence of extrapulmonary tuberculosis in haemodialysis patients was significantly higher (p < 0.01), but it was lower than these reported in the past literature. The seventy nine cases consisted of 52 primary treatment cases, 23 retreatment cases, and 4 unknown cases. Out of 79 cases, 36 cases developed tuberculosis almost at the same time or within 1 year after undergoing haemodialysis, and thereafter it decreased gradually. Underlying diseases for haemodialysis were mainly glomerulonephritis and diabetic nephropathy. There were many patients who failed to notify to the public health centers after the diagnosis of tuberculosis was made, and it is needed to improve such a situation in the future. The prognosis of tuberculosis undergoing haemodialysis was poor. Three out of 43 patients with PTB and 2 out of 13 tuberculosis pleurisy cases died. (3) CONCLUSION: The risk of developing PTB in patients undergoing haemodialysis was not high compared with the general population, however, the risk was much higher for extrapulmonary tuberculosis. Moreover, the treatment outcome was not satisfactory in patients with PTB and pleurisy. As patients undergoing haemodialysis have the factors which suppress the cell-mediated immunity, it is required to restudy the measures to prevent development of tuberculosis, management and treatment in the future.