初治肺结核合并乙型肝炎病毒感染患者抗结核治疗诱发药物性肝损伤的影响因素分析  

Analysis of influencing factors on drug-induced liver injury induced by antituberculosis therapy in patients with newly treated pulmonary tuberculosis combined with hepatitis B virus infection

作　　者：贺毅 李榜龙 李慧 HE Yi;LI Banglong;LI Hui(Department of Tuberculosis,the First Hospital of Changsha City,Changsha 410005,China;Department of Pulmonary and Critical Care Medicine,the First Hospital of Changsha City,Changsha 410005,China)

机构地区：[1]长沙市第一医院结核科,长沙410005 [2]长沙市第一医院呼吸与危重症科,长沙410005

出　　处：《长春中医药大学学报》2024年第4期450-454,共5页Journal of Changchun University of Chinese Medicine

基　　金：湖南省卫生健康委科研计划项目(202103020384);长沙市科技计划项目(kq1907013)。

摘　　要：目的探讨初治肺结核合并乙型肝炎病毒(HBV)感染患者抗结核治疗诱发药物性肝损伤的影响因素。方法回顾性分析2018年12月-2023年1月长沙市第一医院收治的318例初治肺结核合并HBV感染患者的临床资料,根据所选患者抗结核治疗是否诱发药物性肝损伤分为肝损伤组(51例)和无肝损伤组(267例)。比较2组临床资料,并予以多因素Logistic回归分析法分析初治肺结核合并HBV感染患者抗结核治疗诱发药物性肝损伤的危险因素。结果肝损伤组有心血管疾病、内分泌性疾病、其他病毒性肝病史、未服用保肝药物、营养不良、抗结核治疗方案含吡嗪酰胺的患者占比分别为49.02%、41.18%、7.84%、68.63%、39.22%、78.43%,均高于无肝损伤组的34.46%、27.34%、0.00%、49.81%、20.60%、26.59%;血清前白蛋白(PA)、胆碱酯酶(ChE)水平低于无肝损伤组;血清γ-谷氨酰转移酶(GGT)水平及乙型肝炎病毒的脱氧核糖核酸(HBV-DNA)病毒载量高于无肝损伤组(P<0.05)。多因素Logistic回归分析结果显示,内分泌性疾病、其他病毒性肝病史、未服用保肝药物、营养不良、抗结核治疗方案含吡嗪酰胺、血清PA水平低、血清ChE水平低、血清GGT水平高是初治肺结核合并HBV感染患者抗结核治疗诱发药物性肝损伤的独立危险因素(OR=2.782、2.125、2.683、3.364、1.758、1.885、2.408、2.901,P<0.05)。结论内分泌性疾病、其他病毒性肝病史、未服用保肝药物、营养不良、抗结核治疗方案含吡嗪酰胺、血清PA水平低、血清ChE水平低、血清GGT水平高是初治肺结核合并HBV感染患者抗结核治疗诱发药物性肝损伤的独立危险因素,临床可据此给予高危患者针对性的治疗或干预,预防或减少药物性肝损伤的发生。Objective To explore the influencing factors of drug-induced liver injury induced by anti-tuberculosis therapy in patients with newly treated pulmonary tuberculosis combined with hepatitis B virus(HBV)infection.Methods The clinical data of 318 patients with newly treated pulmonary tuberculosis combined with HBV infection admitted to the First Hospital of Changsha City from December 2018 to January 2023 were retrospectively analyzed.According to whether drug-induced liver injury was induced by anti-tuberculosis therapy in the selected patients,they were divided into the liver injury group(51 cases)and the non liver injury group(267 cases).The clinical data of two groups were compared,and the risk factors of drug-induced liver injury induced by anti-tuberculosis therapy in patients with newly treated pulmonary tuberculosis combined with HBV infection were analyzed by multivariate Logistic regression analysis.Results The proportion of patients with cardiovascular diseases,endocrine diseases,history of other viral liver diseases,no use of liver protection drugs,malnutrition,and anti-tuberculosis treatment regimen containing pyrazinamide in the liver injury group was 49.02%,41.18%,7.84%,68.63%,39.22%,and 78.43%,respectively,and all were higher than 34.46%,27.34%,0.00%,49.81%,20.60%,and 26.59% in the non liver injury group.The levels of serum prealbumin(PA)and cholinesterase(ChE)in the liver injury group were lower than those in the non liver injury group;The levels of serum-glutamyltransferase(GGT)and the viral load of hepatitis B virus deoxyribonucleic acid(HBV-DNA)in the liver injury group were higher than those in the non liver injury group(P<0.05).The results of multivariate Logistic regression analysis showed that endocrine diseases,history of other viral liver diseases,no use of liver protection drugs,malnutrition,anti-tuberculosis treatment regimen containing pyrazinamide,low levels of serum PA,and low levels of serum ChE,high levels of GGT were the independent risk factors for drug-induced liver injury induced

关 键 词：肺结核 乙型肝炎病毒 初治 药物性肝损伤 影响因素 

分 类 号：R521[医药卫生—内科学]