肺结核合并HBsAg阳性患者抗结核治疗后发生肝功能损害的危险因素

Risk factors for the occurrence of liver injury after anti-tuberculosis therapy in pulmonary tuberculosis patients with concomitant HBsAg positive

目的探讨肺结核合并HBsAg阳性患者抗结核治疗后发生肝功能损害的危险因素。方法回顾性分析133例肺结核合并HBsAg阳性患者的临床资料,根据抗结核治疗后是否发生肝功能损害将患者分为肝损组与非肝损组。比较肝损组和非肝损组患者的临床资料,采用Logistic回归模型分析肺结核合并HBsAg阳性患者抗结核治疗后发生肝功能损害的危险因素。结果共有47例(35.34%)患者发生肝功能损害,肝损组痰涂片阳性、HBeAg阳性、治疗前HBV-DNA载量≥1.0×10^(3)IU/mL的患者比例均高于非肝损组(均P<0.05)。Logistic回归分析结果显示,痰涂片阳性、HBV-DNA载量≥1.0×10^(3)IU/mL是肺结核合并HBsAg阳性患者抗结核治疗后发生肝功能损害的危险因素(均P<0.05)。结论肺结核合并HBsAg阳性患者抗结核治疗过程中易发生肝功能损害,其中痰涂片阳性和高HBV-DNA载量的患者抗结核治疗后发生肝功能损害的风险增加。

Objective To investigate the risk factors for the occurrence of liver injury after anti-tuberculosis therapy in pulmonary tuberculosis patients with concomitant HBsAg positive.Methods The clinical data of 133 pulmonary tuberculosis patients with concomitant HBsAg positive were retrospectively analyzed.According to whether liver injury after anti-tuberculosis therapy occurred or not,the patients were divided into liver injury group or non-liver injury group.The clinical data of patients were compared between the liver injury group and the non-liver injury group.The Logistic regression model was used to analyze the risk factors for the occurrence of liver injury after anti-tuberculosis therapy in pulmonary tuberculosis patients with concomitant HBsAg positive.Results There were a total of 47(35.34%)cases of patients suffering from liver injury,and the proportions of patients with sputum smear positive,with HBeAg positive and pre-treatment HBV-DNA load≥1.0×10^(3)IU/mL in the liver injury group were higher than those in the non-liver injury group(all P<0.05).The results of Logistic regression analysis revealed that sputum smear positive and HBV-DNA load≥1.0×10^(3)IU/mL were risk factors for the occurrence of liver injury in pulmonary tuberculosis patients with concomitant HBsAg positive after anti-tuberculosis therapy(all P<0.05).Conclusion Pulmonary tuberculosis patients with concomitant HBsAg positive easily suffer from liver injury during anti-tuberculosis therapy,therein the patients with sputum smear positive and high HBV-DNA load are at an increased risk for the occurrence of liver injury after anti-tuberculosis therapy.