摘要
目的探讨采用监测γ干扰素(IFN-γ)血清浓度指导肺结核合并乙型肝炎病毒(HBV)感染患者抗病毒治疗的临床意义。方法对156例肺结核合并HBV感染患者治疗前检测的IFN-γ血清浓度与肝脏炎症活动度半定量积分(SSS)进行相关分析,并依据IFN-γ血清浓度水平及是否接受恩替卡韦抗病毒治疗将受试者分为A组(高IFN-γ血清浓度加用恩替卡韦抗病毒治疗)、B组(高IFN-γ血清浓度)及C组(低IFN-γ血清浓度)。所有肺结核合并HBV感染患者均给予优化抗结核方案(2HTE(S)Lfx/4HT)治疗。结果患者IFN-γ血清浓度与SSS评分呈正相关(r=0.6158,P<0.05),HBV-DNA定量与SSS无相关性(r=0.3265,P>0.05)。A组治疗后,HBV-DNA定量及IFN-γ血清浓度较治疗前明显下降;肝功能损害程度、HBV-DNA定量及IFN-γ血清浓度均明显低于B组(均P<0.01);HBV-DNA定量明显低于C组(P<0.01),但肝功能水平及IFN-γ血清浓度水平与C组比较差异无统计学意义(均P>0.05)。B组治疗后,肝功能损害程度、HBV-DNA定量及IFN-γ浓度均明显高于C组(P<0.01);乙肝再激活率较C组明显升高(P<0.01)。结论 IFN-γ浓度能反映肝脏炎症活动程度,对于高IFN-γ血清浓度的肺结核合并HBV感染患者进行抗结核治疗同时给予恩替卡韦抗病毒治疗,能有效降低肝功能损害率及损害程度,而对低IFN-γ血清浓度患者不进行抗病毒治疗仍有较高的安全性,在肝脏穿刺病理检查困难的条件下,IFN-γ血清浓度有望为此类患者抗结核治疗过程中是否选择抗病毒治疗提供临床依据。
Objective To evaluate the clinical significance of IFN-γserum concentration in guiding the anti-virus treatment of the pulmonary tuberculosis patients with hepatitis B virus(HBV)infection.Methods Before treatment,the serum concentration of IFN-γfor156cases of pulmonary tuberculosis combined with HBV infection was analyzed with semiquantitative scoring system(SSS),and the subjects were divided into group A(high IFN-γserum concentration plus entecavir antivirus treatment),group B(high IFN-γserum concentration)and group C(low IFN-γserum concentration)according to the level of IFN-γserum concentration and the acceptance of entecavir antivirus.All the patients with pulmonary tuberculosis complicated with HBV infection were given optimal anti-tuberculosis regimen(2HTE(S)Lfx/4HT).Results The serum level of IFN-γwas positively correlated with SSS,the correlation coefficient was0.6158(P<0.05),and HBV-DNA was not correlated with SSS(r=0.3265,P>0.05).After treatment,the HBV-DNA and IFN-γserum concentrations in group A were significantly decreased(P<0.05),and the degree of liver function impairment,HBV-DNA and IFN-γconcentration in group A were significantly lower than those of group B after treatment(P<0.01),and the HBV-DNA of group A was significantly lower than that of group C after treatment(P<0.01),but there were no significant differences in liver function and IFN-γserum concentration between group A and group C(P>0.05).The degree of liver function impairment,HBV-DNA and IFN-γconcentration in group B were significantly higher than those of group C after treatment(P<0.01).Compared with group C,the rate of HBV reactivation in group B was significantly increased after treatment(P<0.01).Conclusion The serum concentration of IFN-γcan reflect the degree of liver inflammation,and the anti-tuberculosis and entecavir antiviral treatment for patients with pulmonary tuberculosis combined with HBV infection with high IFN-γserum concentration can effectively reduce the rate and the degree of liver function impairment,b
作者
程海林
胡旭东
宋斌
夏冰
柏涛
田德安
Cheng Hailin;Hu Xudong;Song Bin(Department of Gastroenterology and Liver Disease,Wuhan Medical Treatment Center,Wuhan 430033,China;Department of Tuberculosis,Wuhan Medical Treatment Center,Wuhan 430033,China)
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2018年第6期711-714,共4页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
武汉市卫生计生委资助项目(No.WX14C72)
