HIV/MTB双重感染合并抗结核药物性肝损伤患者的临床特征

Clinical characteristics of HIV-MTB co-infected patients combined with anti-tuberculosis drug-induced liver injury

目的探讨人类免疫缺陷病毒/结核分枝杆菌(HIV/MTB)双重感染合并抗结核药物性肝损伤(ATB-DILI)患者的临床特征。方法回顾性分析2017年10月至2019年10月凉山州布拖县人民医院189例HIV/MTB双重感染合并ATB-DILI患者的临床资料。结果189例患者中,111例(58.7%)为中青年已婚女性,149例(78.8%)来自乡村地区,135例(71.4%)经异性性接触传播感染HIV。ATB-DILI临床分型有肝细胞损伤型105例(55.6%),胆汁淤积型61例(32.3%)和混合型23例(12.1%)。常见临床表现为乏力、食欲减退117例(61.9%),恶心、厌油95例(50.2%),黄疸83例(43.9%),皮肤瘙痒71例(37.6%)等。肝细胞损伤型患者ALT和ALP分别为(324.5±127.1)U/L、(142.7±53.5)U/L,胆汁淤积型分别为(217.3±86.4)U/L、(395.4±156.3)U/L,混合型分别为(243.9±95.3)U/L、(272.5±101.4)U/L。CD4^(+)T淋巴细胞计数<200个/μL 80例(42.3%),尤其是肝细胞损伤型降低最显著。腹部影像学检查变化多样,缺乏特异性。结论HIV/MTB双重感染合并ATB-DILI临床表现多样,以消化系统损伤为主,多数患者预后良好。

Objective To analyze the clinical characteristics of anti-tuberculosis drug-induced liver injury(ATB-DILI)patients co-infected with human immunodeficiency virus and mycobacterium tuberculosis(HIV-MTB).Methods The clinical data of 189 cases admitted to the people’s hospital of Butuo county in Liangshan prefecture from October 2017 to October 2019 were retrospectively analyzed.Results Among 189 enrolled subjects,111 cases(58.7%)were young and middle-aged married women,149 cases(78.8%)were from rural areas,and 135 patients(71.4%)were infected with HIV through heterosexual contact.Most cases of DILI presented with hepatocellular injury(55.6%,Group A),followed by cholecystitis(32.3%,Group B)and mixed type(12.1%,Group C).Patients commonly presented with fatigue and appetit(61.9%),nausea and oil aversio(50.2%),jaundice43.9%),skin itchings(37.6%)and so on.In liver function examination,the ALT level of Group A was higher than that of Group B and Group C[(324.5±127.1)U/L,vs(217.3±86.4)U/L,(243.9±95.3)U/L)].The ALP level of Group B was higher than that of Group A and Group C[(395.4±156.3)U/L vs(142.7±53.5)U/L,(272.5±101.4)U/L.The CD4^(+)T lymphocyte count(<200/μL)decreased significantly in 80 cases(42.3%),especially in Group A(175.9±71.3)/μL The abdominal imaging examinations in the three groups varied with no specificity.Conclusion The clinical manifestations of HIV-MTB co-infected patients combined with ATB-DILI are various,mainly presented with digestive system injury,and the prognosis of most patients is good.However,the early screening and intervention of ATB-DILI population in Liangshan prefecture still need to be strengthened.