HBV-M阳性肺结核患者抗结核化疗的探讨

A STUDY ON THE ANTITUBERCULOSIS CHEMOTHERAPY FORPULMONARY TUBERCULOUS PATIENTS WITH POSITIVE HBV-M

探讨ＨＢＶ－Ｍ阳性肺结核患者抗结核化疗对肝功能的影响。方法：采用酶联免疫吸附试验（ＥＬＩＳＡ）法检测１７８例肺结核患者ＨＢＶ－Ｍ、观察执结核化疗中肝功能变化与ＨＢＶ－Ｍ的关系。结果：１７８例肺结核患者中ＨＢＶ－Ｍ阳性９２例（５１．７％）、阴性８６例（４８．３％）、化疗期间肝功能异常分别为３４．８％和９．４％（Ｐ＜０．００１）。单阳祖、双阳组和三阳组肝功能异常分别为２３．１％，４４．４％和５７．７％，三阳组显著高于单阳组和双阳组（Ｐ＜０．０５）、结论ＨＢＶ－Ｍ阳性肺结核患者可用含ＩＮＨ、ＲＦＰ和Ｐ２Ａ方案，但应并用保肝药。ＨＢＳＡｇ（＋）、ＨＢｅＡｇ（＋）、ＨＢＣＡｂ（＋）模式最好不用Ｐ２Ａ。

Objective: To study the effects of antituberculosis chemotherapy on liver function in the pulmonary tuberculosis patients withpositive HBV-M. Methods: HBV-M and the liver function of 178 patients with pulmonary tuberculosis were investigated. Therelationship between the abnormal liver function and HBV-M during antituberculosis chemotherapy was observed. Results:Positive and negative fate of HBV-M among 178 patients was 51.7% and 48.3% respectively. 34.8% cases (32/92) with positiveHBV-M and 9.3% cases (8/86) with negative HBV-M showed abnormal liver function during antituberculosis chemotherapy,which showed a significant difference (P<0.01). The rate of abnormal liver function in one-positive group (HBsAg. HBeAg andHBcAb), two-positive group (HBsAg. HBeAg and HBsAg. HBcAb) and three-posihve group (HBsAg. HBeAg. HBcAb,andHBsAg. HBeAb. HBcAb) was 23.1%, 44.4% and 57.7% respectively. Comparing with the other two groups, there was a significantdifference in three-positive group (P<0.05). Conclusions: The chemotherapeutic programme of INF. RFP and PZA may bechosen for the pulmonary tuberculosis patients with positive HBV-M. PZA is not Suitable for the patients with positive HBsAg.HBeAg and HBcAb.