血清HBsAg阳性的肺结核患者抗痨治疗引起病毒再激活和药物性肝损伤发生影响因素分析  

Factors influencing the occurrence of hepatitis B viral reactivation and drug-induced liver injury during anti-tuberculosis treatment in patients with serum HBsAg-positive pulmonary tuberculosis

作　　者：郭珍 王欣 牛攀霞[2] Guo Zhen;Wang Xin;Niu Panxia(Section Two,Department of Internal Medicine,Provincial Tuberculosis Prevention and Treatment Hospital,Xi'an710100,Shaanxi Province,China)

机构地区：[1]陕西省结核病防治院内二科,西安市710100 [2]西安医学院第二附属医院感染病科

出　　处：《实用肝脏病杂志》2025年第1期68-71,共4页Journal of Practical Hepatology

基　　金：陕西省科技厅重点研发计划项目(编号:2020SF-105)。

摘　　要：目的分析血清HBsAg阳性的肺结核患者在抗结核治疗过程中病毒再激活和药物性肝损伤(DILI)发生的影响因素。方法2021年1月~2022年12月我院诊治的血清HBsAg阳性肺结核患者120例,均接受标准的抗痨治疗,45例患者接受了恩替卡韦预防性抗病毒治疗。采用多因素Logistic回归分析抗结核治疗过程中病毒再激活和DILI发生的影响因素。结果在抗痨过程中,发生病毒再激活30例(25.0%);病毒再激活组均未接受预防性抗病毒治疗,年龄及长期饮酒、低蛋白血症和应用皮质激素占比分别为(43.5±6.2)岁、60.0%、66.6%和36.7%,均显著大于或高于未发生病毒再激活组【分别为(36.2±5.0)岁、17.7%、20.0%和11.1%,P<0.05】;在抗痨过程中,发生DILI者45例(37.5%);DILI组长期饮酒和低蛋白血症占比分别为55.6%和62.2%,显著高于未发生DILI组(分别为12.0%和13.3%,P<0.05),而接受预防性抗病毒治疗占比为22.2%,显著低于未发生DILI组的46.7%(P<0.05);多因素Logistic回归分析显示,不接受抗病毒治疗、长期饮酒和低蛋白血症是血清HBsAg阳性肺结核患者抗结核治疗过程中病毒再激活的独立危险因素(P<0.05),而长期饮酒、低蛋白血症和不抗病毒治疗是发生DILI的独立危险因素(P<0.05)。结论血清HBsAg阳性的肺结核患者抗痨治疗过程中可能会发生病毒再激活和DILI,了解危险因素,及早做好预防和处理,可能能保证抗痨治疗的顺利进行。Objective The aim of this study was to analyze the factors influencing the occurrence of hepatitis B viral reactivation(HBV-RA)and drug-induced liver injury(DILI)during anti-tuberculosis treatment in patients with serum HBsAg-positive pulmonary tuberculosis(PT).Methods 120 patients with serum HBsAg-positive PT were encountered in our hospital between January 2021 and December 2022,and all received standardized anti-tuberculosis treatment.The preventive entecavir antiviral treatment was given in 45 patients.The influencing factors for HBV-RA and DILI occurrence were analyzed by multivariate Logistic regression.Results The HBV-RA occurred in 30 cases(25.0%)during anti-tuberculosis treatment and all of them didn’t received entecavir antiviral treatment;the age,percentages of drinking hobby,hypoalbuminemia and administration of steroid in patients with HBV-RA were(43.5±6.2)yr,60.0%,66.6%and 36.7%,all significantly greater or higher than[(36.2±5.0)yr,17.7%,20.0%and 11.1%,respectively,P<0.05]in those without HBV-RA,all of whom received entecavir therapy;during anti-tuberculosis treatment,the DILI occurred in 45 cases(37.5%);the percentages of drinking hobby and hypoalbuminemia in patients with DILI were 55.6%and 62.2%,much higher than 12.0%and 13.3%,respectively,P<0.05),while the percentage of persons receiving antiviral therapy was 22.2%,much lower than 46.7%(P<0.05)in those without DILI;the multivariate Logistic regression analysis showed that no antiviral treatment,drinking hobby and hypoalbuminemia were the independent risk factors for the HBV-RA(P<0.05)and the drinking hobby and hypoalbuminemia were the independent risk factors for DILI occurrence in patients with serum HBsAg positive PT(P<0.05).Conclusion The HBV-RA and DILI could occur during antituberculosis treatment in patients with serum HBsAg positive PT,which might be carefully prevented and managed appropriately in clinical practice.

关 键 词：药物性肝损伤 肺结核 HBsAg 抗结核治疗 HBV再激活 危险因素 

分 类 号：R521[医药卫生—内科学] R575[医药卫生—临床医学]