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背景:结核病治疗过程中肝毒性的出现常常导致抗结核治疗的中断,或调整为较弱的治疗方案。目的:评估乙型肝炎病毒(HBV)感染者和未感染者在接受抗结核治疗过程中出现肝毒性的风险,从而制定出一套临床可遵循的预测规律。设计:采用前瞻性观察随访的研究方法。对接受抗结核治疗的154例患者的临床资料进行分析,采用粗风险比率估算并应用Cox比例风险模型分析。结果:平均随访日为187 d,粗风险比率显示种族、人类免疫缺陷病毒感染(HIV)、多个性伴侣、高效联合抗病毒治疗以及结核病的临床类型可摘要能是出现肝毒性的预测因子。虽然无统计学意义,但HBV感染和其他性传播疾病仍显示为相当大的相对危险度。Cox风险比例模型显示以下为出现肝毒性的高危因素:白种人、多个性伴侣、基础谷丙转氨酶升高以及结核病的临床类型。虽然缺乏精确的证据,但通过HBV表面抗原检测证实为活动性乙型肝炎的患者,仍预示可能出现肝毒性。结论:通过以上信息,我们可以根据分值绘制出列线图来估算每一个患者的生存概率和事件发生的中位时间。
BACKGROUND: The appearance of hepatotoxicity during tuberculosis treatment often leads to discontinuation of antituberculosis treatment or adjustment to weaker treatment regimens. OBJECTIVE: To assess the risk of developing hepatotoxicity in hepatitis B virus (HBV) infected and uninfected patients during antituberculosis treatment and to develop a set of clinically followed predictive patterns. Design: A prospective observational follow-up study was conducted. The clinical data of 154 patients receiving anti-TB treatment were analyzed and estimated using the crude risk ratio and analyzed using the Cox proportional hazards model. Results: The average follow-up date was 187 days. Rough-risk ratios showed that genotypes, human immunodeficiency virus (HIV), multiple sexual partners, highly effective combined antiviral therapy and the clinical type of tuberculosis could be a predictor of hepatotoxicity. Although not statistically significant, HBV infection and other sexually transmitted diseases still showed considerable relative risk. The Cox risk proportional model shows the following high risk factors for hepatotoxicity: Caucasians, multiple partners, elevated basal aminotransferase, and the clinical type of tuberculosis. Although accurate evidence is lacking, patients who have been confirmed as active hepatitis B by HBV surface antigen testing are still predicting hepatotoxicity. Conclusion: Based on the above information, we can estimate the survival probability and the median time of occurrence of each patient according to the score drawn from the nomogram.