肝炎病毒感染对抗结核治疗时患者肝功能的影响

【目的】观察合并肝炎病毒感染的结核患者服用抗结核药物后对肝功能的影响。【方法】单纯结核杆菌感染的患者525例，结核杆菌合并肝炎病毒感染43例。两组患者前4个月采用异烟肼、利福平、吡嗪酰胺、乙胺丁醇治疗，后2个月采用异烟肼、利福平治疗，观察抗结核治疗对肝功能的影响。【结果】单纯结核杆菌感染组发生急性药物性肝炎54（10．3％）例，结核杆菌合并肝炎病毒感染组发生急性病毒型肝炎20（46．5％）例，两组有显著性差异（P〈0．05）。急性病毒性肝炎肝功能损害严重（AST：210．6±77．4vs387．4±90．6，P〈0．05；ALT：207．3±45．3vs372．6±88．1，P〈0．01），肝功能恢复时间延迟（27．4±13．5vs41．4±18．3，P〈0．05）。【结论】抗结核杆菌的药物对结核杆菌合并肝炎病毒患者的肝脏毒性较强，治疗过程中定期复查肝功能；抗结核治疗前应该常规检测肝炎病毒。

Effect of Hepatitis Virus Infection on Liver Function in Patients with Tuberculosis During Anti-tuberculosis Treatment

[Objective] To investigate the effect of hepatitis virus infection on liver function of patients with tuberculosis （TB） during anti-tuberculosis treatment. [MethodslA total of 525 patients were only infected with TB and 43 patients were coinfected hepatitis virus and TB. All patients were administrated with identical anti tuberculosis regiment which isoniazid, rifampicin, pyrazinamide and ethambutol were administrated in the first 4 months, and then isoniazid and rifampicin were administrated in the later 2 months. The effect of antiuberculosis treatment on the liver function was observed. [Results] Acute drug-induced hepatitis happened in 54 （10.3%） patients in simple TB group and 20 （46.5%） patients in acute virus hepatitis and TB coinfection group. There was significant difference between two groups （ P〈0.05）. Liver function of patients with acute viral hepatitis was damaged gravely（ AST： 210.6±77.4 vs 387.4±90.6, P 〈0.05;ALT：207.3± 45.3 vs 372.6±88.1, P d0.01） and the recovery of liver function was prolonged （27.4±13.5 vs 41.4±18. 3, P〈0.05）. [Conclusionl Anti-tuberculosis drugs can increase the hepatotoxicity in TB patients complicated with hepatitis virus infection. I.iver function should be reexamined during anti tuberculosis treatment and hepatitis virus should be detected routinely before anti-tuberculosis treatment.