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目的探讨抗结核药物对乙肝病毒标志物阳性肺结核患者肝功能影响及防治对策。方法回顾性分析1276例初治肺结核患者及其中100例药物性肝损害的临床资料。结果 136例乙型肝炎病毒标志物(HBVM)阳性肺结核患者中有54例(39.7%)出现肝损害,HBVM阴性患者1140例中出现肝损害46例(4.0%),两组比较差异有统计学意义(P<0.01)。抗结核治疗后出现肝损害的时间分别为(18.7±11.3)d、(31.5±13.2)d。肝损害的程度ALT分别为(121.1±55.2)U/L、(75.4±32.3)U/L;TBIL分别为(57.0±33.2)μmol/L、(36.8±24.9)μmol/L。两组比较均有统计学意义(P<0.05)。结论抗结核药物对乙肝病毒标志物阳性肺结核患者有一定影响,在抗结核治疗前检查HBVM及肝功能十分必要,对HBVM阳性的患者在抗结核治疗中应密切监测肝功能情况,一旦出现肝损害,应根据肝损害的程度选择适当的抗结核治疗及护肝治疗。
Objective To investigate the effect of anti-tuberculosis drugs on liver function in patients with hepatitis B virus positive pulmonary tuberculosis and its prevention and treatment. Methods The clinical data of 1276 newly diagnosed pulmonary tuberculosis patients and 100 cases of drug-induced liver damage were retrospectively analyzed. Results Of the 136 patients with hepatitis B virus (HBVM) -positive pulmonary tuberculosis, 54 (39.7%) had liver damage, and 1, 4 of HBVM-negative patients had liver damage (46%, 4.0%). There was a statistically significant difference between the two groups Significance (P <0.01). The time of liver damage after anti-TB treatment were (18.7 ± 11.3) days and (31.5 ± 13.2 days) respectively. The severity of liver damage was (121.1 ± 55.2) U / L and (75.4 ± 32.3) U / L, respectively. The TBIL were (57.0 ± 33.2) μmol / L and (36.8 ± 24.9) μmol / L, respectively. The two groups were statistically significant (P <0.05). Conclusion The anti-tuberculosis drugs have certain influence on hepatitis B virus positive pulmonary tuberculosis patients. It is very necessary to check HBVM and liver function before antituberculosis treatment. For patients with HBVM positive, the liver function should be closely monitored during anti-TB treatment. Once liver damage occurs , Should be based on the degree of liver damage to choose the appropriate anti-TB treatment and liver protection treatment.