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*

doi:10.3969/j.issn.1672-5069.2025.01.018

Abstract

Abstract: 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.

Key words: Drug-induced liver injury, Pulmonary tuberculosis, HBsAg, Anti-tuberculosis treatment, Hepatitis B viral reactivation, Risk factors

Guo Zhen, Wang Xin, Niu Panxia. 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[J]. Journal of Practical Hepatology, 2025, 28(1): 68-71.

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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

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