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丙型肝炎病毒合并感染会增加肺结核患者抗结核药物所致肝毒性的风险。

Hepatitis C virus co-infection increases the risk of anti-tuberculosis drug-induced hepatotoxicity among patients with pulmonary tuberculosis.

作者信息

Lomtadze Nino, Kupreishvili Lali, Salakaia Archil, Vashakidze Sergo, Sharvadze Lali, Kempker Russell R, Magee Matthew J, del Rio Carlos, Blumberg Henry M

机构信息

National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.

Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.

出版信息

PLoS One. 2013 Dec 19;8(12):e83892. doi: 10.1371/journal.pone.0083892. eCollection 2013.

Abstract

BACKGROUND

The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection.

PURPOSE

To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy.

METHODS

Prospective cohort study; HCV serology was obtained on all study subjects at the time of TB diagnosis; hepatic enzyme tests (serum alanine aminotransferase [ALT] activity) were obtained at baseline and monthly during treatment.

RESULTS

Among 326 study patients with culture-confirmed TB, 68 (21%) were HCV co-infected, 14 (4.3%) had chronic hepatitis B virus (HBV) infection (hepatitis B virus surface antigen positive [HBsAg+]), and 6 (1.8%) were HIV co-infected. Overall, 19% of TB patients developed mild to moderate incident hepatotoxicity. In multi-variable analysis, HCV co-infection (adjusted Hazards Ratio [aHR]=3.2, 95% CI=1.6-6.5) was found to be an independent risk factor for incident anti-TB drug-induced hepatotoxicity. Survival analysis showed that HCV co-infected patients developed hepatitis more quickly compared to HCV seronegative patients with TB.

CONCLUSION

A high prevalence of HCV co-infection was found among patients with TB in Georgia. Drug-induced hepatotoxicity was significantly associated with HCV co-infection but severe drug-induced hepatotoxicity (WHO grade III or IV) was rare.

摘要

背景

格鲁吉亚国家结核病(TB)和丙型肝炎病毒(HCV)感染的患病率很高。

目的

确定HCV合并感染是否会增加一线抗结核药物治疗患者发生药物性肝炎的风险。

方法

前瞻性队列研究;在结核病诊断时对所有研究对象进行HCV血清学检测;在基线时以及治疗期间每月进行肝酶测试(血清丙氨酸氨基转移酶[ALT]活性)。

结果

在326例经培养确诊为结核病的研究患者中,68例(21%)合并HCV感染,14例(4.3%)患有慢性乙型肝炎病毒(HBV)感染(乙肝表面抗原阳性[HBsAg+]),6例(1.8%)合并HIV感染。总体而言,19%的结核病患者发生了轻度至中度的药物性肝损伤。在多变量分析中,发现HCV合并感染(校正风险比[aHR]=3.2,95%置信区间=1.6-6.5)是抗结核药物性肝损伤的独立危险因素。生存分析表明,与HCV血清学阴性的结核病患者相比,HCV合并感染的患者肝炎发病更快。

结论

在格鲁吉亚的结核病患者中发现HCV合并感染的患病率很高。药物性肝损伤与HCV合并感染显著相关,但严重的药物性肝损伤(世界卫生组织III级或IV级)很少见。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c6b/3868578/3a83b8d7a05c/pone.0083892.g001.jpg

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