781例初治肺结核患者抗结核组合药物间歇疗法肝损害的调查

目的 调查抗结核药物对合并HBV感染的结核病患者肝功能损害的特点,补充和完善实施DOTs策略的内容.方法 研究采用历史性队列研究方法,回顾性分析2004年6月至2005年10月住院治疗的781例初治结核病患者病历资料,分为HBsAg(+)组和HBsAg(-)组.结果 781例调查对象肝功能损害率为20.74%,其中HBsAg(+)组121例(74.69%),HBsAg(-)组41例(25.31%),经统计学分析,HBsAg(+)组发生肝损害率、ALT、AST平均值比HBsAg(-)组高;HBsAg(+)组最早出现肝功能损害为治疗的第7天,HBsAg(-)组最早出现肝功能损害为治疗的第16天,HBsAg(+)组的平均时间比HBsAg(-)组早18.09 d;HBsAg(+)组肝功能恢复的平均时间为57.02 d,HBsAg(-)组为27.56 d,HBsAg(+)组比HBsAg(-)组晚29.46 d.结论 合并HBV感染的结核病患者抗结核药物肝损害发生率高于未合并HBV感染的患者;HBV感染程度越严重,肝损害发生率越高,且发生时间提早,损害程度严重.

Study on liver damage caused by anti-TB drug intermittent treatment on patients with HBV-TB co-infection

Objective To study the features of liver damage caused by anti-TB medicines among patients with TB-HBV co-infection, in order to complement and improve the implementation of DOTs strategy in the region. Methods A historical cohort study was conducted including the process of reviewing and analyzing files of the 781 naive TB patients hospitalized from June 2004 to October 2005. Cases were divided into HBsAg (+) group and HBsAg (-) group. Results The overall damage rate among the 781 investigation cases was 20.74%, including 121 cases (74.69%) in HBsAg (+) group and 41 cases (25.31%) in HBsAg (-) group. Data showed that liver damage rate and average value of ALT and AST of HBsAg (+) group were higher than those in HBsAg (-) group. First case with liver damage in HBsAg (+) group happened on the 7th day of the treatment, while the first liver damage case happened in HBsAg (-) group was on the 16th day. The average onset in HBsAg (+) group was earlier than HBsAg (-) group for 18.09 days. The average time of liver function recovery in HBsAg (+) group was 57.02 days and in HBsAg (-) group it was 27.56 days while the appearance among HBsAg (+) group was 29.46 days later than in HBsAg (-) group. Conclusion The incidence rate of liver damage caused by anti-TB medicines was higher among HBV positive patients than those HBV negative patients. Patients co-infected with HBV infection appeared to be more serious, with higher incidence on liver damage and earlier onset, as well as with the degree of damage to the liver.