周广俭

[摘要] 目的 对708例住院结核患者（包括肺结核、结核性胸膜炎，下称结核患者）在抗结核药物治疗过程中出现肝损伤的临床特点及治疗进行探讨。 方法 比较乙肝标志物阳性（HBsAg阳性、HBeAg阳性或阴性、HBcAb阳性或阴性）的结核病患者与乙肝标志物阴性的结核患者在治疗期间肝功能损害情况。 结果 乙肝标志物阳性患者肝损害发生率32.1%，乙肝标志物阴性患者肝损害发生率15.0%，两者相比差异有显著性（P＜0.01）。乙肝标志物阳性患者无因肝损伤更换抗结核药物方案，乙肝标志物阴性患者有2例因肝损害需更改治疗方案占0.3%。 结论 乙肝标志物阳性患者在抗结核药物治疗过程中易发生肝损害，对这类患者应7d左右复查肝功能，尽可能抗结核治疗同时加用保肝药物，个别肝损伤严重患者应更换肝损害较小的抗结核药。

[关键词] 肺结核；结核性胸膜炎；乙肝标志物；肝损伤

[中图分类号] R595.3   [文献标识码] B   [文章编号] 2095-0616（2014）08-163-03

The liver injury during hospitalization in patients with TB: A clinical analysis of 708 cases

ZHOU Guangjian

Huaxian Central Hospital in Henan Province, Huaxian 456400, China

[Abstract] Objective To explore the clinical features of liver injury during the treatment by anti tuberculosis drugs in tuberculosis patients(including tuberculous pleurisy, tuberculosis). Methods The damage of liver function was compared between liver markers positive(including tuberculous pleurisy, tuberculosis) and negative during the treatment of TB patients. Results The incidence of liver injury was 32.1% and 15.0% respectively in HBV markers positive and negative patients, with significant difference (P＜0.01). There was no replacemen treatment regimens due to liver injury in HBV markers positive patients,the treatment programs was replaced in two cases due to liver damage in HBV markers negative patients,accounting for 0.3%. Conclusion Markers of hepatitis B patients during the treatment of anti tuberculosis drugs prone to liver damage,liver function should be reviewed around 7d in such patients,as far as possible anti tuberculosis therapy combined with liver protecting drugs,some serious liver damage should be replaced with anti tuberculosis drugs liver lesion smaller.

[Key words] Tuberculosis;Tuberculous pleurisy;HBV markers; Liver injury

肺结核、结核性胸膜炎与乙型肝炎是我国常见病、多发病，部分患者合并发生。药物性肝损伤是由药物或其代谢产物引起的肝功能检测异常，是抗结核治疗的常见问题[1]。结核患者在抗结核治疗中容易出现肝功能异常导致治疗中断或失败[2]。现将我院2010年1月～2012年12月收治的708例结核患者包括合并乙型肝炎患者53例的临床资料分析报道如下。

1 资料与方法

1.1 一般资料

所有病例均经胸片、胸部CT、痰涂片抗酸杆菌检查、PPD试验、结核抗体检查确诊。本组708例患者中男515例，女193例；年龄11～89岁，平均45岁；……