HIVTB患者抗结核治疗强化期发生肝损伤的危险因素.pdfVIP

中华临床医师杂志( 电子版)2013 年10 月第7 卷第20 期 Chin J Clinicians(Electronic Edition),October 15,2013,Vol.7,No.20 ·9047 · ·临床论著· HIV/TB 患者抗结核治疗强化期发生 肝损伤的危险因素 邹俊 刘燕芬 吴念宁 欧汝志 秦英梅 谢志满 陆宁 【摘要】 目的 探讨HIV/TB 患者在标化抗结核治疗强化期，肝损伤的发生情况及其影响因素。 方法 对采用标化抗结核治疗的400 例HIV/TB 患者，观察强化期肝损伤发生率。选择15 个可能对肝损伤 产生影响的临床指标行Logistic 回归分析。结果 本组HIV/TB 患者抗结核肝损伤的发生率为36.25% 。单 因素分析显示：体重减轻、既往肝损伤史、静脉途径用药、CD4＋T 淋巴细胞计数、白蛋白定量、合并HBV 感染以及治疗后嗜酸性粒细胞增高与抗结核时肝损伤相关。多因素分析显示：既往肝损伤史、体重减轻、 静脉途径用药发生肝损伤的危险系数分别为3.24、2.289 、2.328 ；白蛋白定量高、CD4＋T 淋巴细胞计数升高， 发生肝功能损伤的可能性降低为0.918、0.996 。结论 HIV/TB 患者既往有肝损、体重减轻、静脉途径用药 是抗结核发生肝损伤的主要危险因素。白蛋白定量高及CD4＋T 淋巴细胞计数增高可降低肝损伤的风险。 【关键词】 获得性免疫缺陷综合征； 危险因素； 抗结核治疗； 肝损伤 Risk factors for liver damage in HIV/TB patients who were treated by anti-tuberculosis ZOU Jun, LIU Yan-fen, WU Nian -ning, OU Ru-zhi, QIN Ying-mei, XIE Zhi-man, LU Ning. The Fourth Hospital of Nanning, AIDS Clinical Treatment Center of Guangxi, Nanning 530023, China Corresponding author: WU Nian-ning, Email: wunianning62@163.com 【Abstract 】 Objective To study the occurrence and the risk factors for liver damage in HIV/TB patients who were treated by anti-tuberculosis in standardized intensive phase. Method The variables from clinical and biochemical examinations of 400 cases of AIDS/TB were evaluated by Logistic regression analysis in order to determine the risk factors for liver damage in anti-tuberculosis treatment. Results The incidence of liver damage was 36.25%. With the simple factor analysis, emaciation, past history of liver injury, intravenous administration , ＋ CD4 T-lymphocyte count, serum albumin quantitative, co-infected with HBV and eosinophils count were the risk factors. The risk of liver damage coefficients were 3.24, 2.289, 2.328 for emaciation, past history of liver injury and intravenous a