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目的:探讨免疫调节剂在预防肺结核合并HBs Ag阳性患者抗结核治疗后肝损伤发生的作用。方法:以广州市胸科医院2014年1月至2015年12月就诊的肺结核并HBs Ag阳性患者136例为研究对象,将肺结核并HBV-DNA阳性患者抗结核联合抗病毒治疗的基础上,加用免疫调节剂治疗者为A组(n=21);肺结核并HBV-DNA阴性患者抗结核并加用免疫调节剂治疗者为B组(n=24)。将HBV-DAN阳性患者抗结核联合抗病毒治疗未予免疫调节剂治疗者为C组(n=43);HBV-DNA阴性单纯抗结核治疗者为D组(n=48)。回顾性分析各组患者治疗两个月药物性肝损伤的发生情况。结果:在HBV-DNA阳性患者人群中,A组与C组肝损伤发生率无明显差异(33.3%vs 34.9%,P>0.05);在HBV-DNA阴性患者人群中,B组肝损伤发生率虽低于D组,但无统计学意义(16.7%vs 25.0%,P>0.05)。结论:肺结核并HBs Ag阳性患者在抗结核治疗期间,无论HBV-DNA阳性或阴性,给予免疫调节剂治疗,对降低药物性肝损伤的发生率效果不明显。
Objective: To investigate the role of immunomodulatory agents in the prevention of liver injury after antituberculous therapy in patients with tuberculosis and HBsAg-positive patients. Methods: Thirty-six patients with tuberculosis and HBsAg positive who visited Guangzhou Thoracic Hospital from January 2014 to December 2015 were selected as the research objects. Based on the combination of anti-tuberculosis and antiviral treatment of tuberculosis and HBV-DNA positive patients, Patients treated with immunomodulatory agents were Group A (n = 21). Patients with tuberculosis and HBV-DNA-negative anti-TB and immunomodulatory agents were Group B (n = 24). Group C (n = 43) received HBV-DNA positive anti-TB combined antiviral therapy without immunomodulator treatment; Group D (n = 48) treated HBV-DNA negative anti-TB therapy alone. Retrospective analysis of the two groups of patients with drug-induced liver injury in the incidence of two months. Results: Among HBV-DNA positive patients, there was no significant difference in the incidence of liver injury between group A and group C (33.3% vs 34.9%, P> 0.05). Among HBV-DNA negative patients, the incidence of liver injury in group B Although it is lower than D group, it is not statistically significant (16.7% vs 25.0%, P> 0.05). CONCLUSION: Immunotherapy with immunomodulatory agents, whether positive or negative for HBV-DNA, is not effective in reducing the incidence of drug-induced liver injury in TB patients with HBsAg-positive disease during anti-TB treatment.