摘要
乙型肝炎病毒(hepatitis B virus,HBV)感染和结核杆菌(mycobacterium tuberculosis,MTB)感染迄今依然是分别居于我国法定病毒性传染病和细菌性传染病榜首的重大疾患.由此导致的慢性乙型肝炎(chronic hepatitis B CHB)和肝硬化(liver cirrhosis,LC)、肝癌(hepatocellular carcinoma,HCC)以及肺结核病(pulmonary tuberculosis,PTB)对人类健康威胁巨大.随着HBV和MTB感染的持续流行及慢性化病例的不断增加,CHB合并PTB正逐渐成为新的社会问题.合并感染后其疾病过程、机体伤害、治疗药物选择、治疗效果、耐药状态与药物不良反应等均有别于二者之一的单纯感染,尤其对临床预后、病原治疗、抗结核药物所致肝损伤(antituberculosis drug induced liver injury,ATLI)甚至诱发耐多药结核(multidrug-resistan pulmonary tuberculosis,MDR-TB)等方面的负性影响,正成为临床新的棘手难题.本文就二者合并感染的发病情况及其临床发现、不良后果、目前诊疗中存在的问题及合并感染的抗痨治疗、抗HBV与护肝治疗特点进行了总结.并结合国内目前的诊疗现状,就如何提高合并感染的治疗效果提出进一步建议.
Hepatitis B virus（HBV） and tuberculosis bacillus（TB） are leading causes of infectious diseases in China, leading to a range of lifethreaten diseases including chronic hepatitis B（CHB）, cirrhosis, hepatocellular carcinoma（HCC） and pulmonary tuberculosis（PTB）. Due to the high prevalence of infection and increased number of cases, coinfection of HCC and PTB is becoming a new hot area. Differences between coinfection and single infection include the disease process, injuries, medication selection, curative effects, drugresistance and side effects. In particular, the adverse effects of clinical prognosis, etiological treatment, anti-tuberculosis drug induced liver injury（ATLI） and multidrugresistant pulmonary tuberculosis（MDR-TB） have became a new challenge for therapy. This review aims to summarize the incidence of infections, clinical observations, adversely effects and existing problems of treatment, the development of antituberculous and anti-HBV therapy and hepatitis protection. Additionally, a suggestion for improving therapeutic effi cacy has been proposed as well.
出处
《世界华人消化杂志》
CAS
2016年第18期2785-2798,共14页
World Chinese Journal of Digestology
基金
桂林市科技局立项基金资助项目
No.20110119-6~~
关键词
慢性乙型肝炎
肺结核
合并感染
抗痨治疗
核苷(酸)类似物
药物性肝损伤
Chronic hepatitis B
Tuberculosis
Infection
Anti-tuberculosis therapy
Nucleoside（acid） analogues
Drug-induced liver injury
