血清胆碱酯酶临床评估HBV感染合并肺结核患者抗结核治疗致肝损伤价值

摘要

目的:分析血清胆碱酯酶(CHE)在评估乙型肝炎病毒(HBV)感染合并肺结核患者抗结核治疗致肝损伤的临床价值.方法:纳入我院112例HBV感染合并肺结核患者(合并组)、94例单纯肺结核患者(单纯组)和102例健康体检者(健康组),肺结核患者均接受抗结核治疗,检测所有患者血清CHE水平和肝功能指标,分析CHE与肝功能指标相关性.结果:治疗期间,合并组肝功能正常率16.07％,轻度损伤率44.64％,重度损伤率39.29％,单纯组为21.28％、61.70％和17.02％,两组差异具有统计学意义(P<0.05);血清CHE从高到底为合并组、单纯组和健康组,差异具有统计学意义(P<0.05),肝功能损伤程度越严重,血清CHE水平越低(P<0.05);治疗后,合并组HBV-DNA定量、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸转氨酶(AST)均显著上升(P<0.05),CHE水平显著下降(P<0.05);血清CHE与TBIL、ALT和AST呈显著负相关性(r=-0.712,0.723,0687,P<0.05);血清CHE分析抗结核治疗致肝损伤的ROC曲线结果显示,曲线下面积为0.912(P<0.05),诊断临界值为4325.54U/L,血清CHE诊断灵敏度91.49％、特异度83.33％、阳性预测值96.63％、阴性预测值65.22％、正确度90.18％,诊断效能高.结论:血清CHE可较好的反应HBV感染合并肺结核患者抗结核治疗过程中肝脏炎症损伤程度,诊断效能高,可为抗结核治疗期间早期抗病毒治疗提供参考.%Objective:To analyze the clinical value of serum cholinesterase ( CHE) in evaluating liver injury induced by antituberculosis therapy in patients with hepatitis B virus ( HBV) infection and pulmonary tuberculosis. Methods:112 cases of patients with HBV infection and pulmonary tuberculosis ( combined group) , 94 cases of patients with simple pulmonary tuberculosis ( simple group ) and 102 healthy subjects ( healthy group) were enrolled in the study. All patients with pulmonary tuberculosis received antituberculosis treatment. Serum CHE levels and liver function indexes were detected, and the correlation between CHE and liver function indexes was analyzed. Results:During the treatment, the normal rate of liver function, the mild injury rate and the severe injury rate in the combined group were 16.07％, 44.64％ and 39.29％, respectively while those in the simple group was 21.28％, 61.70％ and 17.02％, respectively (P<0.05).The serum CHE level ranged from high to low were the combined group, the simple group and the healthy group, and the difference was statistically significant ( P<0.05) , and the more serious liver injury, the lower serum CHE level (P<0.05). After treatment, the levels of HBV-DNA quantification, total bilirubin(TBIL), alanine amin-otransferase ( ALT) and aspartate aminotransferase ( AST) of the combined group were significantly increased (P<0.05), while CHE level was significantly decreased (P<0.05). Serum CHE was negatively correlated with TBIL, ALT and AST ( r=-0.712, 0.723,0687, P<0.05) . The ROC curve results of liver injury induced by anti tuberculosis treatment and analyzed by serum CHE showed that the area under the curve was 0.912 ( P<0.05) and the diagnostic critical value was 4325.54U/L, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of serum CHE diagnosis were 91.49％, 83.33％, 96.63％, 65. 22％ and 90.18％ with high diagnostic efficiency. Conclusion:Serum CHE can well reflect the degree of liver injury and high diagnostic efficiency in patients with HBV infection and pulmonary tuberculosis during antitu-berculosis treatment, which provides references for early antiviral therapy.