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目的了解广西地区人类免疫缺陷病毒(HIV)及结核(TB)双重感染病人(HIV/TB病人),在标化抗结核治疗强化期药物性肝炎的发生情况,分析发生药物性肝炎的影响因素。方法以同期HIV阴性的TB病人作对照,选择16个可能对发生药物性肝炎产生影响的因素进行Spearman相关性分析,对单因素分析有统计学意义的影响因素进行Logistic回归模型多因素分析。结果符合观察条件的HIV/TB病人共369例,药物性肝炎发生率为22.8%(84例);HIV阴性的TB共350例,药物性肝炎发生率为13.1%(46例),两组比较差异有统计学意义(P<0.001)。HIV/TB组治疗失败47例,其中与药物性肝炎相关占63.8%。单因素分析HIV/TB病人药物性肝炎的危险因素为女性、体质量减少、合并乙型肝炎病毒(HBV)或/和丙型肝炎病毒(HCV)感染、既往有肝损伤病史、血清蛋白降低、低CD+4T淋巴细胞计数、静脉途径用药、用药后嗜酸性粒细胞计数升高;多因素分析显示:体质量减少、既往有肝损伤病史、低CD+4T淋巴细胞计数、静脉用药、用药后嗜酸性粒细胞计数升高,是导致药物性肝炎的危险因素。结论 HIV/TB病人抗结核治疗易出现药物性肝炎,对预后影响大;HIV感染后体质下降和免疫异常是导致药物性肝炎发生率高的主要原因。
Objective To understand the HIV / TB patients (HIV / TB patients) in Guangxi and to identify the incidence of drug-induced hepatitis during the intensive anti-TB treatment and to analyze the influencing factors of drug-induced hepatitis. Methods Sixteen patients with HIV-negative TB were enrolled in this study. Spearman’s correlation analysis was used to determine the possible influencing factors of drug-induced hepatitis and the multivariate logistic regression model was used to analyze the influencing factors of univariate analysis. Results A total of 369 HIV / TB patients were eligible for observation. The incidence of drug-induced hepatitis was 22.8% (84 cases). The total number of HIV-negative TB patients was 350 and that of drug-induced hepatitis was 13.1% (46 cases) The difference was statistically significant (P <0.001). In the HIV / TB group, 47 cases failed to be treated, of which 63.8% were related to drug-induced hepatitis. Univariate analysis revealed that the risk factors for drug-induced hepatitis in HIV / TB patients were women with reduced body mass, combined with hepatitis B virus (HBV) or / and hepatitis C virus (HCV) infection, previous liver injury history, decreased serum protein, Low CD + 4T lymphocyte count, intravenous route of medication, eosinophil count increased after treatment; multivariate analysis showed that: the body weight decreased, history of previous liver injury, low CD 4T lymphocyte count, intravenous medication, after treatment Elevated eosinophil count is a risk factor for drug-induced hepatitis. Conclusion Anti-TB treatment of HIV / TB patients is prone to drug-induced hepatitis, which has a great effect on prognosis. The main cause of high incidence of drug-induced hepatitis is the physical decline and immune dysfunction after HIV infection.