Research Of Liver Function Damage Among HBsAg-positive Patients As The Result Of Chemical Anti-tuberculosis Treatment

Objective To observe the relationship between Hepatic injury due to anti-tuberculosis drugs and infection with hepatitis B virus(HBV) in patients with tuberculosis.To study the characteristic of liver function damage of anti-tuberculosis drugs to hepatitis B patients in view of Guangxi,in order to make the chemotherapy to be more reasonable.To supplement and consummate DOTS strategy,and provide scientific and theory basis to toberculosis preventing and controlling work in guangxi.Method This is a historical cohort study.Extracts 3 Guangxi tuberculosis faculty hospital (Guangxi Longtan Hospital,Nanning the fourth people hospital,Beihai toberculosis prevention institute)and 1 Centers for Disease Control and Prevention(Wuming Centers for Disease Control and Prevention).Reviewing analysis 511 examples(every patient conform the diagnosis standard formulated in 2001 by the guide of pulmonary tuberculosis diagnosis and treatment).After HBVM designated,221 examples of HBsAg(+)are the observation group,290 examples of HBsAg(-)are the controlling group.Compare the Hepatic injury rate,the time,the ascension degree of ALT and AST with two groups,the cure results and so on.Results In 511 examples of investigate object,there are 106 liver function damage examples(20.74%),which the HBsAg(+)group are 79(35.75%),the HBsAg(-)group are 27(9.31%),two groups have significance differences of statistics(P＜0.05).Among the HBsAg(+)patients,HBsAg(+)(A group)patient's is 19.44%,HBsAg(+),HBeAb(+)或HBeAg(+)或HBcAb(+)(B group)patient's is 38.10%,HBsAg,HBcAb,HBeAb(+)(C group)patient's is 60.38%,HBsAg,HBcAb,HBeAg(+)(Dgroup)patient's liver damage ratio is 54.55%.A group and B group,A group and C+D group, B group and C+D group have significance difference in statistics(P＜0.05),but C group and D group have no significance difference in statistics(P＞0.05),. The ALT and AST in HBsAg(+)group is 189.15±25.23(U/L)and 179.45±24.45(U/L)respectively,and in the HBsAg(-)group,there are 54.43±12.31(U/L)and 45.13±9.53(U/L),two groups has the significance difference in statistics(P＜0.05).After being treatment,there are 8 people's ALT elevate to 600U/L in HBsAg(+)group,and no one in HBsAg(-)group.The clinical manifestation such as digestive tract,the jaundice and the allergy etal of HBsAg(+)patients are more than the HBsAg(-)group,but the liver splenomegaly and other performance are fewer.The mean time of liver function damage appear in 16.03 days in HBsAg(+)group,but in 34.93 days in HBsAg (-)group,that is 18.09 days earlier.The appearance of hepatic injury in 1 month is 64.56%in the HBsAg(+)group,and 33.33%in the HBsAg(-)group,two groups has the significance difference in statistics(P＜0.05).The mean time of liver functions restore is 57.02 days in HBsAg(+)group,but in 27.56 days in HBsAg(-)group,that is 29.46 days later.Among the 511 examples,4.70% change the medicine in the course of treatment,when 16.24%stop to take the medicine.The resons of stop taking the medicine are liver damage(63.86%), stops medicine voluntarily(16.87%),economical reason(21.69%)and other factors(9.64%).In 79 the tuberculosis and hepatitis B dual infection patients which has the liver damage,there are 45 cases stop taking the medicine,that is 43.04%can continue to be treated.And 70.37%in the non-merge hepatitis B patients,two groups have the significance difference in statistics(P＜0.05);The total average treatment expense is 6391.89 Yuan,that HBsAg(+)group is 6596.25 Yuan and the HBsAg(-)group is 6216.38 Yuan.The average days in hospital of total observers is 27.59 days,that HBsAg(+)group is 18.52 days and the HBsAg(-)group is 34.51 days.The daily cost of HBsAg(+)group is 176.04 yuan more than HBsAg(-)group.Conclusion The Hepatic injury rate of hepatitis B patients is higher than the non- infectors,and more easily and early to have liver fuction damage than the non-infectors.Moreover,The rate of stop taking the medicine of hepatitis B patients is higher than the non- infectors, and the daily cost of HBsAg(+)patients is 176.04 yuan more than HBsAg (-)patients.We should aim at the situation Guangxi hepatitis B succeeding in the imperial civil service examinations,not only carry out the national tuberculosis treatment and control measure,but also promote practical and effective tuberculosis control strategy conforming to Guangxi's actual situation.