丙型肝炎而非乙型肝炎病毒是抗结核药物性肝损伤的一个危险因素。
Hepatitis C and not Hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury.
作者信息
Kim Wan Soo, Lee Sang Soo, Lee Chang Min, Kim Hong Jun, Ha Chang Yoon, Kim Hyun Jin, Kim Tae Hyo, Jung Woon Tae, Lee Ok Jae, Hong Jeong Woo, You Hyun Seon, Cho Hyun Chin
机构信息
Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Gangnam-ro 79, Jinju, Gyeognam, 660-702, South Korea.
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Palyong-ro, 158, MasanHoiwon-gu, Chang-Won, Republic of Korea.
出版信息
BMC Infect Dis. 2016 Feb 1;16:50. doi: 10.1186/s12879-016-1344-2.
BACKGROUND
The risk of anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic viral hepatitis (CVH) is not clear. The aim of this study was to investigate incidence and risk factors associated with TB DILI in CVH and non-CVH patients.
METHODS
Retrospectively, a total of 128 CVH patients who received anti-TB medication from January 2005 to February 2014 were reviewed. Among these, 83 patients had hepatitis B virus (HBV), 41 patients had hepatitis C virus (HCV) and 4 patients were dual hepatitis B and hepatitis C virus co-infected (HBV + HCV) with 251 non-CVH patients who received anti-TB medication selected as the controls. There were no human immunodeficiency virus co-infected patients. Risk factors for DILI were analyzed using cox regression analysis.
RESULTS
The incidence of DILI was significantly higher in the HCV group (13/41 [31.7%], p < 0.001) and HBV + HCV groups (3/4 [75.0%], p = 0.002) compared to the control group (25/251 [10.0%]). The incidence of transient liver function impairment in the hepatitis B virus group was higher than in the control group (18/83 [21.7%] vs. 27/251 [10.8%] p = 0.010), but not in DILI (11/83 [13.3%] vs. 25/251 [10.0%], p = 0.400). In total patients, HCV, HBV + HCV co-infection, older age, and baseline liver function abnormality were independent factors of DILI.
CONCLUSIONS
It is recommended to carefully monitor for DILI in patients with HCV or HBV/HCV co-infection, older age, and baseline liver function abnormality.
背景
慢性病毒性肝炎（CVH）患者发生抗结核（TB）药物性肝损伤（DILI）的风险尚不清楚。本研究旨在调查CVH患者和非CVH患者中TB DILI的发生率及相关危险因素。
方法
回顾性分析2005年1月至2014年2月期间接受抗结核治疗的128例CVH患者。其中，83例为乙型肝炎病毒（HBV）感染，41例为丙型肝炎病毒（HCV）感染，4例为乙型和丙型肝炎病毒双重感染（HBV+HCV），选取251例接受抗结核治疗的非CVH患者作为对照。无人类免疫缺陷病毒合并感染患者。采用Cox回归分析DILI的危险因素。
结果
与对照组（25/251 [10.0%]）相比，HCV组（13/41 [31.7%]，p<0.001）和HBV+HCV组（3/4 [75.0%]，p=0.002）的DILI发生率显著更高。乙型肝炎病毒组的短暂性肝功能损害发生率高于对照组（18/83 [21.7%] 对27/251 [10.8%]，p=0.010），但在DILI方面无差异（11/83 [13.3%] 对25/251 [10.0%]，p=0.400）。在所有患者中，HCV、HBV+HCV合并感染、年龄较大和基线肝功能异常是DILI的独立危险因素。
结论
建议对HCV或HBV/HCV合并感染、年龄较大及基线肝功能异常的患者密切监测DILI。
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