肺结核合并慢性乙型肝炎病毒携带者肝组织学改变与抗结核药所致肝损伤的关系

Relationship between Liver Histological Changes of Tuberculosis Patients with HBV Co-infection and Anti-tuberculosis Agents Induced Liver Injury

目的探讨肺结核合并慢性乙型肝炎病毒（hepatitis B virus,HBV）携带者肝组织学改变与抗结核药所致肝损伤的关系。方法对63例肺结核合并慢性HBV携带者进行肝活检,分析肝脏病理分级、分期及血清乙型肝炎病毒载量水平、E抗原与抗结核药所致肝损伤的关系。结果肝脏有病理改变者62例（98.41%）,其中G1、G2、G3分别为49例（77.78%）、9例（14.29%）、2例（3.17%）;S1、S2、S3分别为34例（53.97%）、13例（20.63%）、3例（4.76%）。抗结核疗程结束后累积发生抗结核药所致肝损伤25例（39.68%）。病理分级G0-G1组抗结核药所致肝损伤发病率低于G2、G3组（χ~2=9.885,P〈0.01）。病理分期S0~S1组抗结核药所致肝损伤发病率低于S2~S3组（χ~2=7.571,P〈0.01）。乙型肝炎e抗原（hepatitis Be antigen,HBe Ag）阳性组抗结核药所致肝损伤发病率高于HBe Ag阴性组（χ~2=9.877,P〈0.01）。血清HBV-DNA≤1000 IU/ml组抗结核药所致肝损伤发病率为35.29%（6/17）,血清HBV-DNA〉1000 IU/ml组为41.30%,两组差异无统计学意义（χ~2=0.187,P〉0.05）。结论肺结核合并慢性HBV携带者抗结核药所致肝损伤与肝组织病理分级、分期的程度及E抗原阳性与否相关,与血清乙型肝炎病毒载量水平无统计学相关。

Objective To discuss the relationship between liver histological changes of the tuberculosis patients with hepatitis B virus（ HBV） co-infection and anti-tuberculosis agents induced liver injury. Methods Sixty-three pulmonary tuberculosis patients co-infection with HBV underwent liver biopsy. The histological data and quantity of serum HBV-DNA and HBe Ag were analyzed statistically. Results Sixty-two patients（ 98. 41%） had histological changes in liver,among whom 49 patients（ 77. 78%） were G1,9（ 14. 29%） were G2,2（ 3. 17%） were G3,34（ 53. 97%） were S1,13（ 20. 63%） were S2 and 3（ 4. 76%） were S3. At the end of anti-tuberculosis treatment accumulatedly 25 cases had liver injury（ 39. 68%）. The incidence of liver injury with the grade of liver inflammation G0-G1 was lower than that of G2-G3（ χ~2= 9. 885,P 〈 0. 01）. The incidence of liver injury in S0-S1 stage of liver fibrosis was lower than that of S2-S3（ χ~2= 7. 571,P 〈 0. 01）. The incidence of liver injury in Hbe Ag positive patients was higher than that of Hbe Ag negative（ χ~2= 9. 877,P 〈 0. 01）. The incidence rate of liver injury in patients with the serum HBV-DNA HBV-DNA≤1000 IU / ml and 〉 1000 IU / ml was 35. 29%（ 6 /17） and 41. 30%（ 19 /46） respectively,which were not significantly different（ χ~2= 0. 187,P 〉 0. 05）. Conclusion The incidence of anti-tuberculosis agents induced liver injury is correlated with titers of grade of liver inflammation,stage of liver fibrosis and positive Hbe Ag,and not correlated with the titers of serum HBV-DNA level.