肝肾功能及血常规参数在肺结核患者药物治疗过程中的变化及临床意义

Changes and clinical significance of liver and kidney function and blood routine parameters in patients with pulmonary tuberculosis during medication

目的分析活动性肺结核患者进行抗结核药物治疗前后肝肾功能和血常规的变化及不良反应情况,探寻能用于抗结核治疗疗效的监测指标。方法选取2019年1月至2020年1月在娄底市中心医院接受抗结核药物治疗的55例活动性肺结核患者为病例组,选取同期55名健康人群为对照组。收集相关临床资料和检验结果,记录病例组在抗结核药物治疗过程中的不良反应,检测病例组和对照组入组前血常规和肝肾功能及病例组治疗前后的肝肾功能和血常规相关参数动态变化。结果治疗前病例组的白细胞计数(WBC)和血小板/淋巴细胞比值(PLR)与对照组比较,差异无统计学意义(P>0.05);病例组的红细胞分布宽度(RDW)和中性粒细胞/淋巴细胞比值(NLR)高于对照组,差异有统计学意义(P<0.05)。病例组患者中肝功能损害发生率最高,其中谷丙转氨酶(ALT)和/或谷草转氨酶(AST)增高发生率18.18%,胆红素(TBil)升高发生率10.91%,其次为胃肠道反应(14.55%)。尿酸(UA)升高、过敏反应、白细胞下降、血小板下降发生率分别为9.09%、3.64%、7.27%、3.64%。病例组治疗前后WBC、PLR、TBil比较,差异无统计学意义(P>0.05),治疗后患者的RDW、NLR低于治疗前,ALT和/或AST、UA高于治疗前,差异有统计学意义(P<0.05)。结论进行抗结核治疗的患者需要定期评估血常规及肝肾功能,密切关注不良反应,进行及时有效干预。RDW、NLR等参数对监测活动性肺结核的治疗效果具有重要的临床应用价值。

Objective To analyze the changes of liver and kidney function,blood routine and adverse reactions in patients with active pulmonary tuberculosis before and after anti-tuberculosis drug treatment,and to find out the monitoring indicators that can be used for the efficacy of anti-tuberculosis treatment.Methods A total of 55 patients with active pulmonary tuberculosis who received anti-tuberculosis drug treatment in Loudi Central Hospital from January 2019 to January 2020 were selected as case group,and 55 healthy people in the same period were selected as control group.The related clinical data and test results were collected,and the adverse reactions during anti-tuberculosis drug treatment in the case group were recorded.The dynamic changes of blood routine and liver and kidney function before and after treatment in the case group and the control group were detected.Results Before treatment,there were no significant differences in white blood cell count(WBC)and platelet/lymphocyte ratio(PLR)between case group and control group(P>0.05).The red blood cell distribution width(RDW)and neutrophil/lymphocyte ratio(NLR)in the case group were higher than those in the control group,and the differences were statistically significant(P<0.05).The incidence of liver function damage was the highest in the case group,among which the incidence of alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)increased was 18.18%,the incidence of bilirubin(TBil)increased was 10.91%,followed by gastrointestinal reaction(14.55%).The incidence of elevated uric acid(UA),allergic reaction,leukopenia and thrombocytopenia were 9.09%,3.64%,7.27% and 3.64%,respectively.There were no significant differences in WBC,PLR and TBil before and after treatment in the case group(P>0.05).RDW and NLR were lower after treatment than before treatment,ALT and/or AST and UA were higher than before treatment,and the differences were statistically significant(P<0.05).Conclusion Patients undergoing antituberculosis therapy need regular evaluation of blood routine and liver and kidney function,close attention to adverse reactions,and timely and effective intervention.RDW,NLR and other parameters have important clinical application value in monitoring the therapeutic effect of active pulmonary tuberculosis.