抗结核化疗形成非酒精性脂肪性肝病危险因素分析

【摘要】目的 探讨肺结核（TB）抗结核治疗后形成非酒精性脂肪肝（NAFLD）相关危险因素。方法选取2012年8月至2015年8月初治肺结核患者616例，其中单纯TB组患者300例，抗结核治疗后TB＋NAFLD组患者316例。收集两组患者的临床资料、检测肝肾功能、血脂和血糖等。组间比较用凇验，非条件Logistic回归分析筛选肺结核抗结核治疗后形成非酒精性脂肪肝主要危险因素。结果与单纯TB组比较，TB＋NAFLD组患者多为男性、高龄、高水平γ-谷胺酰转肽酶，应用左氧氟沙星和水飞蓟宾比例偏低，差异有统计学意义（P〈0．05）；Logistic逐步回归分析显示，性别、年龄、药物左氧氟沙星和水飞蓟宾是独立危险因素（OR值分别是2．250、4．392、0．231和0．001，P〈0．05）。结论高龄、男性、高水平γ-谷胺酰转肽酶患者易有抗结核治疗后形成脂肪肝的倾向；应用左氧氟沙星和水飞蓟宾有助于减少脂肪肝的发生，具保护作用。

Objective To Compare and explore risk factors related to Tuberculosis pulmonary （ TB ） and the development of nonalcoholic fatty liver disease （ NAFLD ） . Methods A total of 616 in-patients with TB （ TB group, 300 cases ） and TB with NAFLD （ TB＋ NAFLD group, 316 cases ） were enrolled in the study between August 2012 and August 2014. Clinical data collected for analysis included levels of blood lipids, liver function markers, urinic function markers, blood glucose levels and therapy plan. The t-test and X2-test were used for statistical analysis. Risk factors of TB with NAFLD were assessed by using logistic regression analysis. Results Compared with the TB group, the TB＋ NAFLD group had higher age, manal patients and levels of gamma glutamine transferase （ γ -GGT ） （ all P〈0.05 ） , but lower levels at the combined levofloxacin and silymarin treatment. Logistic analysis showed that sexy, Age and the combined levofloxacin and silyrnarin treatment. Were the major risk factors of TB with NAFLD （ OR=2.250, 4.392, 0.231 and 0.001, respectively; all P〈0.05 ） . Conclusion Patients with a propensity for developing nonalcoholic fatty liver disease may experience elder onset of manal Tuberculosis pulmonary. TB with NAFLD have more severe γ -GGT metabolism disorders. The treatment of levofloxacin and silymarin may decrease the developing NAFLD of TB patients.