抗病毒联合抗结核治疗HBV-DNA阳性初治肺结核的疗效及肝功能、IFN-γ、SSS评分相关性分析

Efficacy of combined antiviral and anti-tuberculosis therapy in the treatment of initial pulmonary tuberculosis patients with positive HBV-DNA and the correlation of hepatic function with IFN-γand SSS scores

目的 分析抗病毒联合抗结核治疗乙肝病毒的脱氧核糖核酸(HBV-DNA)阳性初治肺结核的疗效并分析患者干扰素-γ(IFN-γ)、半定量积分系统(SSS)评分与肝功能的相关性。方法 选择2022年3月—2023年3月南通大学附属如皋医院收治的120例HBV-DNA阳性初治肺结核患者作为研究对象,按随机数字表法分为2组,各60例。对照组采取常规抗结核治疗,观察组在对照组基础上联合抗病毒治疗。患者均治疗6个月,比较2组临床疗效(病灶吸收、痰菌转阴、HBV-DNA转阴情况);治疗前、治疗后肝功能、炎症因子水平;比较2组不同时点(治疗前、治疗1、3、6个月)IFN-γ、HBV-DNA、SSS评分水平;采用双变量相关性Pearson分析肝功能、IFN-γ、SSS评分的相关性。结果 观察组病灶吸收、痰菌转阴、HBV-DNA转阴患者占比高于对照组(P<0.05);治疗后,2组谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)水平高于治疗前,白细胞介素-2(IL-2)、IL-6、IL-8、肿瘤坏死因子-α(TNF-α)水平低于治疗前,观察组低于对照组(P<0.05);治疗1、3、6个月时IFN-γ水平高于治疗前,观察组低于对照组,2组时点、组间比较差异具有统计学意义(P<0.05);治疗1、3、6个月时观察组HBV-DNA水平相较于治疗前逐步降低,而对照组HBV-DNA水平相较于治疗前升高,观察组低于对照组,2组时点、组间比较差异具有统计学意义(P<0.05);治疗1、3、6个月时SSS评分高于治疗前,但观察组低于对照组,2组时点、组间比较差异具有统计学意义(P<0.05);双变量相关性Pearson分析结果显示,IFN-γ水平与HBV-DNA阳性初治肺结核患者ALT、AST、TBiL、SSS评分呈正相关(r>0,P<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05)。结论 HBV-DNA阳性初治肺结核经抗病毒联合抗结核治疗能够有效提升临床治疗效果,降低机体炎症及HBV-DNA水平,避免肝脏损伤,稳定肝功能,且不会增加患者发生不良反应的风险。

Objective To analyze the efficacy of combined antiviral and anti-tuberculosis therapy in the treatment of initial pulmonary tuberculosis patients with positive hepatitis B virus deoxyribonucleic acid(HBV-DNA)and the correlation of interferon-γ(IFN-γ)and semi-quantitative scoring system(SSS)score with hepatic function.Methods A total of 120 initial pulmonary tuberculosis patients with positive HBV-DNA who were admitted to Rugao Hospital Affiliated to Nantong University from March 2022 to March 2023 were selected.According to the random number table method,they were divided into two groups(n=60):a control group and an observation group.The control group underwent conventional anti-tuberculosis therapy,while the observation group received antiviral therapy in addition to anti-tuberculosis therapy.All the patients were treated for six months.Both groups were compared for clinical efficacy,including lesion absorption,negative conversion of sputum culture,and HBV-DNA negative conversion,as well as hepatic function and inflammatory factors levels before and after treatment.The levels of IFN-γ,HBV-DNA and SSS scores at different time points(before treatment,and 1,3 and 6 months after treatment)were compared between the two groups.The Pearson correlation coefficients of hepatic function with IFN-γand SSS scores were calculated.Results The observation group showed higher proportions of patients with lesion absorption,negative conversion of sputum culture and HBV-DNA negative conversion than those in the control group(P<0.05).After treatment,increased levels of ALT,AST and TBiL and decreased levels of IL-2,IL-6,IL-8 and TNF-were seen in the two groups,compared with those before treatment,where the changes in the observation group were less obvious than those in the control group(P<0.05).Compared with those before treatment,the levels of IFN-γincreased after treatment for 1,3 and 6 months,where the levels of IFN-γin the observation group were lower than those in the control group,with statistical differences(P<0.05).Compared with those before treatment,the levels of HBV-DNA in the observation group gradually decreased after treatment for 1,3,and 6 months,and those in the control group increased,where the levels of HBV-DNA in the observation group were lower than those in the control group(P<0.05).Compared with those before treatment,the levels of SSS scores increased after treatment for 1,3 and 6 months,where the levels of SSS scores in the observation group were lower than those in the control group,with statistical differences(P<0.05).According to Pearson correlation analysis,IFN-γlevels were positively correlated with ALT,AST,TBiL and SSS scores in initial pulmonary tuberculosis patients with positive HBV-DNA(r>0,P<0.05).There was no statistical difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Combined antiviral and anti-tuberculosis therapy can effectively improve the clinical outcome of initial pulmonary tuberculosis patients with positive HBV-DNA,reduce inflammation and HBV-DNA levels,avoid hepatic damage,and stabilize hepatic function,without increases in the risk of adverse reactions.