两种抗结核化疗方案对肺结核患者肝功能影响的比较

Comparison of the effects two treatments for tuberculosis on liver function in patients with pulmonary tuberculosis

目的 对比 HRZE(S)和 HL AMKO两种抗结核化疗方案对肝脏功能的影响 ,探讨抗结核治疗过程中 HBV携带与肝功能损害的关系 .方法 选择肺结核患者 2 17例 ,随机分成 HRZE(S)和 HL AMKO两个治疗组 ,于治疗前和治疗后每 2 wk检测肝功能 ,并观察临床症状 ,比较两种化疗方法对肝功能的影响 ;同时分析 4 7例合并 HBV携带者肝功能的变化 .结果 2 17例患者中 ,不同程度肝功能损害者共 6 6例(30 .4 % ) ,应用 HRZE(S)方案组 5 3例 (46 .1% ) ,明显高于HL AMKO方案组 13例 (12 .7% ) ;肺结核合并 HBV携带者发生肝功损害者 2 6例 (5 5 .3% ) ,明显高于非 HBV携带者 4 0例 (2 3.5 % ) .结论 HL AMKO方案对肝功能的损害小 ;对合并 HBV携带患者应选肝损害小的治疗方案 ,同时应用保肝药物 .

AIM To compare the effects of two treatments for tuberculosis on liver function in patients with tuberculosis, and to study the differences in liver dysfunction between hepatitis B virus carriers (HBV). METHODS 217 patients with tuberculosis were divided into HRZE(S) and HLAMKO treatment groups, liver function tests were monitored once2 weeks before and after the treatments, and the hepatotoxicity of 47 HBV carriers was assessed during anti tuberculosis therapy. RESULTS 66 patients out of the 217 patients suffered hepatotoxicity, and the incidence of liver dysfunction was significantly higher in HRZE(S) than in HLAMKO ( P <0.01), 46.1% and 24% respectively. The rate of hepatotoxicity in 26 (55.3%) TB patients with HBV infection during the anti TB therapy was higher than in the 40 (23.5%) patients without HBV. CONCLUSION HRZE(S) in the treatment of TB has a higher incidence rate of liver dysfunction than HLAMKO; and is higher in than in those without HBV. The incidence of hepatotoxicity during the anti TB therapy. Therefore we should pay special attention to associated hepatic risk factors.