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

Assessement of liver function damage among HBVM-positive patients as the result of chemical anti-tuberculosis treatment

Objective To assess the liver function damage among HBVM-positive patients as the result of anti-tuberculosis treatment and examine possible coping method. Methods A retrospective analysis of 691 inpatients was made. All the patients had positive mycobacterium tuberculosis as confirmed in their sputa examination.The rate of liver function damage in the HBVM-positive cases (Group B n=97) and in the HBVM-negative cases (Group B n=594) was compared. Results Seventy-three cases had liver function damage out of 691 (10.56%), 44 cases had liver function damage out of Gourp A (45.36%), as compared 29 cases in group B (4.88%): P < 0.01. There were 546 cases who used RFP and 68 cases had liver function damage (12.45%), whereas 145 cases using RFT and 5 had liver function damage (3.45%): P < 0.01. There were 88 HBVM positive cases who used RFP 44 had liver function damage (48.86%), whereas there were 458 HVBM negative cases using RFP and 25 had the damage (5.46%): P < 0.01. There were 9 HBVM positive cases whose treatment plans had included RFT and 1 had the damage (11.1%): P < 0.05. Conclusion Due to the use of anti-tuberculosis treatment, the HBVM positive patients obviously had increased their chances of damaging their liver function.The use of RFP seems to have caused more damage as compared to the use of RFT. It is thus recommended that for the HBVM positive patients RFT and other liver-less-damage drugs shouldbe used the treatment of tuberculosis for the protection of liver.