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目的检测肺结核并血清乙型肝炎病毒DNA(HBV-DNA)及其它乙肝病毒标志物(HBV-M),观察肺结核患者抗结核化疗中肝功能损害与血清HBV-DNA的关系。方法血清HBV-DNA用荧光PCR方法检测。肺结核合并HBV-DNA阳性组,肺结核合并HBV-DNA阴性其它HBV-M阳性组,单纯肺结核组采用以链霉素、利福平、异烟肼、吡嗪酰胺及乙胺丁醇的化疗方案,疗程半年,三组患者均随访5.8年。结果268例肺结核患者血清HBV-M阳性率为19.0%,HBV-DNA阳性20例(7.5%);化疗中,肺结核合并HBV-DNA阳性组、肺结核合并HBV-DNA阴性其它HBV-M阳性组、单线性肺结核组,肝功能受损率分别为95%、10%及5.1%。肺结核合并HBV感染组、单纯HBV-M携带者组、单纯肺结核组,肝功能受损率分别为95%、10%及5.1%。肺结核合并HBV-DNA阳性组死亡4例(15%),且死亡与肝病直接相关(肝衰竭),5.8年后发生肝硬化2例。结论检测肺结核患者血清HBV-DNA有重要意义。抗乙型肝炎病毒治疗对改善存在HBV复制的肺结核患者的预后可能有重要作用,化疗前常规检查并有HBV感染的肺结核患者血清HBV-DNA,可指导用药。
Objective To detect the clinical significance of hepatitis B virus DNA (HBV-DNA) and other hepatitis B virus markers (HBV-M) in patients with pulmonary tuberculosis and to investigate the relationship between the liver damage and serum HBV-DNA in patients with tuberculosis. Methods Serum HBV-DNA was detected by fluorescence PCR. Tuberculosis with HBV-DNA positive group, tuberculosis with HBV-DNA negative other HBV-M positive group, tuberculosis group with streptomycin, rifampicin, isoniazid, pyrazinamide and ethambutol chemotherapy, Half a course of treatment, three groups of patients were followed for 5.8 years. Results The positive rate of HBV-M in 268 cases of tuberculosis was 19.0% and that of HBV-DNA was 20 cases (7.5%). In the chemotherapy group, the positive rate of HBV- In the group of single-line pulmonary tuberculosis, the rates of liver dysfunction were 95%, 10% and 5.1% respectively. Tuberculosis with HBV infection, HBV-M carriers alone group, simple pulmonary tuberculosis group, liver function damage rates were 95%, 10% and 5.1%. Four cases (15%) died of pulmonary tuberculosis complicated with HBV-DNA positive group, and the death was directly related to liver disease (liver failure). Two cases of cirrhosis occurred after 5.8 years. Conclusion Detection of serum HBV-DNA in patients with tuberculosis is of great significance. Anti-HBV treatment may have an important role in improving the prognosis of patients with tuberculosis in the presence of HBV replication. HBV-DNA in patients with tuberculosis prior to chemotherapy and HBV infection may be used as a guideline.