血清前白蛋白检测在治疗继发性肺结核合并乙型肝炎患者药物性肝损伤的诊断价值分析

Diagnostic Value of Serum Prealbumin in the Treatment of Drug-induced Liver Injury in Patients with Secondary Pulmonary Tuberculosis and Hepatitis B

目的:探讨血清前白蛋白(PA)检测在诊断继发性肺结核合并乙型肝炎患者药物性肝损伤中的应用价值。方法:回顾性分析2016年11月—2018年10月我院收治的90例乙型肝炎患者病例资料,根据CT、肝组织活检结果将45例继发性肺结核合并乙型肝炎患者作为观察组,45例未合并继发性肺结核的乙型肝炎患者作为对照组,对观察组患者抗结核药物治疗前后及两组患者血清PA、谷丙转氨酶(ALT)、谷草转氨酶(AST)动态监测结果做分析与比较。结果:观察组患者用药治疗前血清PA、ALT、AST与对照组相比,差异无统计学意义(P>0.05);与治疗前相比,观察组患者血清PA浓度明显降低,ALT、AST浓度均升高且超出正常范围,差异有统计学意义(P<0.05);观察组治疗3个月后血清PA、ALT、AST发生异常变化率均高于治疗2周后,同时各阶段血清PA发生异常变化率均高于ALT、AST,差异有统计学意义(P<0.05);经治疗观察组患者32例恢复良好,13例恢复欠佳,且与恢复欠佳患者相比,治疗后各阶段恢复良好患者PA值均较高,差异有统计学意义(P<0.05)。结论:血清PA、ALT、AST水平在判断继发性肺结核合并乙型肝炎患者药物性肝损伤中均可发挥重要应用价值,且血清PA更具敏感性,可作为抗结核药物治疗至肝功能受损的重要检测指标。

Objective: To evaluate the value of serum prealbumin (PA) in the diagnosis of drug-induced liver injury in patients with secondary pulmonary tuberculosis and hepatitis B. Methods: The data of 90 patients with hepatitis B admitted to our hospital from November 2016 to October 2018 were analyzed retrospectively. According to the results of CT, liver biopsy, 45 patients with secondary pulmonary tuberculosis complicated with hepatitis B were selected as the observation group. 45 cases of hepatitis B patients without secondary pulmonary tuberculosis served as control group. Serum PA, alanine aminotransferase (PA,) and alanine aminotransferase (ALT), were measured before and after antituberculous drug therapy in the observation group and in both groups. AST) dynamic monitoring results were analyzed and compared. Results: There was no significant difference in serum PA,ALT,AST between the observation group and the control group before treatment (P>0.05). Compared with before treatment, the serum PA concentration in the observation group was significantly lower, and the ALT, AST concentration was higher than that in the normal range. The difference was statistically significant (P<0.05). The abnormal rate of serum PA, ALT, AST in the observation group after 3 months of treatment was higher than that after 2 weeks of treatment, and the abnormal rate of serum PA in each stage was significantly higher than that in ALT, AST (P<0.05). After treatment, 32 patients in the observation group recovered well and 13 patients recovered poorly. Compared with the patients with poor recovery, the PA value of the patients with good recovery after treatment was higher than that of the patients with poor recovery (P<0.05), and the difference was statistically significant (P<0.05). Conclusion: Serum PA,ALT,AST level may play an important role in the diagnosis of drug-induced liver injury in patients with secondary pulmonary tuberculosis and hepatitis B, and serum PA is more sensitive. It can be used as an important index to detect liver function damage after antituberculous drug therapy.