Wang Ning-Tao, Huang Yi-Shin, Lin Meng-Hsien, Huang Bryan, Perng Chin-Lin, Lin Han-Chieh
Division of Chest Medicine, Department of Internal Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan, ROC.
Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2016 Jul;79(7):368-74. doi: 10.1016/j.jcma.2015.12.006. Epub 2016 Mar 28.
Antituberculosis drug-induced liver injury (ATDILI) is a major safety concern for the treatment of tuberculosis (TB). The impact of chronic hepatitis B infection (CHBI) on the risk of ATDILI is still controversial. In this study, we aimed to assess systematically the influence of CHBI on the susceptibility to ATDILI.
We reviewed all English-language medical literature with the medical subject search headings hepatitis B and antitubercular agents from the major medical databases. Thereafter, a systematic review and meta-analysis was performed on those publications that qualified.
A total of 938 citations were retrieved on the initial major database search, from which 15 studies were determined to be eligible for analysis. While undergoing anti-TB treatment, 575 cases with drug-induced liver injury (DILI) and 4128 controls without DILI were enrolled into this analysis. The pooled odds ratio of all studies for the CHBI to ATDILI was 2.18 (95% confidence interval, 1.41-3.37). Among the studies with a strict definition of DILI (alanine aminotransferase > 5 × upper limit of normal value) and combination anti-TB regimen, the impact of CHBI on ATDILI was significant only in the prospective studies (odds ratio, 3.41; 95% confidence interval, 1.77-6.59), but not in the case-control studies. However, in the studies with a strict definition of DILI and isoniazid only treatment, the association between CHBI and ATDILI was not statistically significant.
This meta-analysis suggests that CHBI may increase the risk of ATDILI in the standard combination therapy for active TB. Close follow-up and regular liver test monitoring are mandatory to treat TB in chronic hepatitis B carriers.
抗结核药物性肝损伤（ATDILI）是结核病（TB）治疗中的一个主要安全问题。慢性乙型肝炎感染（CHBI）对ATDILI风险的影响仍存在争议。在本研究中，我们旨在系统评估CHBI对ATDILI易感性的影响。
我们在主要医学数据库中检索了所有以乙型肝炎和抗结核药物为医学主题词的英文医学文献。此后，对符合条件的出版物进行了系统评价和荟萃分析。
在最初的主要数据库检索中，共检索到938篇文献，其中15项研究被确定符合分析条件。在接受抗结核治疗的过程中，本分析纳入了575例药物性肝损伤（DILI）患者和4128例无DILI的对照。所有研究中CHBI与ATDILI的合并比值比为2.18（95%置信区间，1.41 - 3.37）。在对DILI有严格定义（丙氨酸氨基转移酶>5×正常值上限）且采用联合抗结核方案的研究中，CHBI对ATDILI的影响仅在前瞻性研究中显著（比值比，3.41；95%置信区间，1.77 - 6.59），而在病例对照研究中不显著。然而，在对DILI有严格定义且仅使用异烟肼治疗方案的研究中，CHBI与ATDILI之间的关联无统计学意义。
这项荟萃分析表明，在活动性结核病的标准联合治疗中CHBI可能增加ATDILI的风险。对于慢性乙型肝炎携带者的结核病治疗，密切随访和定期肝功能检查监测是必不可少的。
