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目的分析川南地区人类免疫缺陷病毒(HIV)/艾滋病(AIDS)合并结核感染者在抗结核治疗中肝损伤的发生情况及临床特征。方法对2012年1月至2014年12月在西南医科大学附属医院感染科就诊的138例诊断为HIV/AIDS合并结核感染肝损伤患者(HIV阳性结核组)的临床资料进行回顾性分析,并以同期就诊的145例HIV阴性的结核病患者作对照(HIV阳性结核组),评估两组在抗结核治疗过程中肝损伤的发生率、程度及对预后的影响。结果 HIV/AIDS合并结核患者肝损伤发生率为26.09%,HIV阴性的结核患者肝损伤发生率为11.72%,前者肝损伤发生率明显高于后者(χ2=9.583,P<0.01)。两组肝损伤患者年龄、性别比较差异无统计学意义(P均>0.05);两组肝损伤发生时间均以抗结核治疗后4周内构成比稍高,但无统计学差异(χ2=1.007,P>0.05)。肝细胞损伤类型两组均以混合型构成比最高,不同肝损伤类型构成比存在差异(χ2=7.314,P<0.01)。HIV阳性结核组患者出现肝损伤后的治疗有效率较HIV阴性结核组有所降低,但差异无统计学意义(74.22%vs94.22%,P>0.05)。结论 HIV/AIDS合并结核患者抗结核治疗中更容易发生肝损伤,对预后影响较大。
Objective To analyze the occurrence and clinical characteristics of liver injury in anti-TB treatment of HIV-infected patients with tuberculosis in southern Sichuan. Methods A retrospective analysis was performed on the clinical data of 138 cases diagnosed as HIV / AIDS-infected patients with hepatic injury (HIV-positive TB) from January 2012 to December 2014 in the Department of Infectious Diseases, Affiliated Hospital of Southwest Medical University. One hundred and forty-five HIV-negative tuberculosis patients treated during the same period (HIV-positive TB group) were enrolled in the study to evaluate the incidence and extent of liver damage and the prognosis of the two groups during anti-tuberculosis treatment. Results The incidence of liver injury was 26.09% in HIV / AIDS patients with tuberculosis and 11.72% in HIV-negative patients with tuberculosis. The incidence of liver injury in the former was significantly higher than that in the latter (χ2 = 9.583, P <0.01). There was no significant difference in age and sex between the two groups (P> 0.05). The incidence of liver injury in both groups within 4 weeks after anti-TB therapy was slightly higher (χ2 = 1.007 , P> 0.05). The types of hepatocyte injury in both groups were the highest proportion of mixed type and the different ratio of different types of liver injury (χ2 = 7.314, P <0.01). The effective rate of treatment after liver injury in HIV-positive TB patients was lower than that in HIV-negative TB patients, but the difference was not statistically significant (74.22% vs94.22%, P> 0.05). Conclusion HIV / AIDS patients with tuberculosis are more likely to develop liver damage during antituberculosis treatment and have a greater impact on prognosis.