乙型肝炎患者抗结核治疗时肝损害的Meta分析  

A meta-analysis of liver lesions in hepatitis B patients undergoing anti-tuberculosis therapy

作　　者：郑宜翔[1] 马淑娟[2] 谭德明[1] 鲁猛厚[1] 

机构地区：[1]中南大学湘雅医院感染科中南大学湘雅医院病毒性肝炎湖南省重点实验室,长沙410008 [2]南方医科大学公共卫生与热带医学学院

出　　处：《中华肝脏病杂志》2014年第8期585-589,共5页Chinese Journal of Hepatology

基　　金：国家“十二五”重大科技专项子课题

摘　　要：目的系统分析乙型肝炎患者在抗结核治疗时不同免疫状态对发生肝损害的影响。方法用循证医学的方法，用计算机在Pubmed、Embase、万方数据库、中国生物医学文献光盘数据库、中国期刊全文数据库中检索国内外公开发表的关于HBV携带者与非乙型肝炎患者抗结核治疗肝损害发生的病例对照研究，辅以手工检索。共纳入7篇文献，对于纳入文献中的乙型肝炎患者进一步分为HBeAg阳性组和HBeAg阴性组，与非乙型肝炎患者的抗结核治疗进行比较分析。采用x^2检验和检验统计量，。对纳入的文献进行异质性检验；采用失安全系数对发表偏倚进行分析。结果乙型肝炎患者在抗结核治疗时出现肝损害的危险性是非乙型肝炎患者的5．83倍（比值比为5．83，95％可信区间为4．27～7．95）。而进一步亚组分析结果显示，HBeAg阳性免疫耐受期患者在抗结核治疗时发生肝损害的危险性是HBeAg阴性非活动性HBV携带者的2．10倍（比值比为2．10，95％可信区间为1．47～2．99）。结论HBV感染是抗结核治疗时发生肝损害的危险因素，HBeAg阳性的乙型肝炎患者相对其他免疫状态的乙型肝炎患者，其危险性更高。Objective To evaluate the effect of different immune status on the incidence of hepatic lesions in patients with hepatitis B virus （HBV） infection undergoing anti-tuberculosis therapy. Methods The PubMed （1966 - 2013）, Embase （1966 - 2013）, Wanfang （1998 - 2013）, Chinese National Knowledge Infrastructure （CNKI; 1997 - 2013）, and Chinese Biomedical （CBMdisc; 1860 - 2013） literature databases were searched for case-control studies of hepatic lesions in patients undergoing anti-tuberculosis therapy with or without concomitant HBV infection. The HBV patients were divided into subgroups according to hepatitis B e antigen （HBeAg） positivity or negativity, all members of the control group were HBsAg （-）. The data from all 7 studies included in the meta-analysis were extracted and analysed using RevMan5.2 software. Results Patients with HBV infection who were undergoing anti-tuberculosis therapy had a higher risk factor than the control patients （OR = 5.81, 95% CI = [4.26, 7.39]）. The HBV patients with HBeAg positivity who were undergoing anti-tuberculosis therapy had a high risk factor than the HBV patients with HBeAg negativity （OR = 2.56, 95% CI = [1.90, 3.44]）. Conclusion HBV infection is a risk factor for hepatic lesions when undergoing anti-tuberculosis therapy, and HBeAg-positive status may put a patient at higher risk.

关 键 词：肝炎 乙型 慢性 抗结核 肝损害 META分析 

分 类 号：R512.62[医药卫生—内科学]