Analysis Of Characteristics And Risk Factors Of Anti-tuberculosis Drug-induced Liver Injury In Patients With HBV Infectio

Objective:The aim of this study was to find the clinical features of ATLI patients with HBV infection,and to find the risk factors of ATLI patients with HBV infection.To provide reference for early clinical detection and treatment of ATLI patients with HBV infection.Methods:A total of 519 patients diagnosed as"tuberculosis"and with HBV infection in Changsha Central Hospital from January 2020 to January 2022 were screened out through the medical record system.A total of 289 cases were obtained by inclusion and exclusion criteria,which were divided into 217 cases in the group without ATLI(HBV-non-ATLI group)and 72cases in the group with ATLI(HBV-ATLI group).The same number of patients(72)as the HBV-ATLI group,with no HBV infection ATLI in the same period,same sex and within 5 years of age difference(ATLI-only group)were also selected.The relevant data of the above patients were collected for retrospective analysis,and the clinical characteristics and risk factors for the development of ATLI in patients with combined HBV were derived.Results:1.Among 289 patients with tuberculosis combined with HBV,the incidence of ATLI was 24.9%(72/289).Antiviral treatment was a independent protective factor for the occurrence of HBV-ATLI(P<0.05,OR<1),while positive HBVDNA and hypoproteinemia were independent risk factors for the occurrence of HBV-ATLI(P<0.05,OR>1).2.Prophylactic antiviral therapy can significantly reduce the incidence of ATLI in patients with HBV(X~2=5.248,P<0.05).Further separate analysis revealed that prophylactic antiviral treatment significantly reduced the incidence of ATLI in HBVDNA-positive patients(X~2=5.248,P<0.05),while the difference was not statistically significant in HBVDNA-negative patients(X~2=0.608,P>0.05).3.Clinical features of ATLI patients with HBV infection(compared with ATLI patients without HBV infection):(1)ATLI patients with HBV infection were more likely to present clinical symptoms,and the difference was statistically significant(52.8%vs 36.1%,P<0.05).The main symptoms of ATLI in both groups were digestive tract symptoms.(2)The prognosis of liver injury in ATLI patients with HBV was worse,and the difference was statistically significant(number of unhealed cases:23.6%vs 9.7%,P<0.05).(3)There was no significant difference in the incidence of liver failure between the two groups(4.2%vs 0%,P>0.05).(4)The difference in time to ATLI between the two groups was not statistically significant(median time:34 days vs31 days,P>0.05).However,the peak time in both groups was within 2 months of taking anti-tuberculosis drugs.Conclusion:1.ATLI patients with HBV infection is more likely to present clinical symptoms than ATLI patients without HBV infection,and the prognosis of liver injury is worse.2.Prophylactic antiviral therapy significantly reduces the overall incidence of ATLI in patients with co-infection with HBV.prophylactic antiviral therapy in HBVDNA positive patients significantly reduces the incidence of ATLI.3.Prophylactic antiviral therapy is an independent protective factor for ATLI patients with HBV infection,while HBVDNA positive and hypoproteinemia are independent risk factors for ATLI with HBV infection.