Abstract：Objective To analyze the high risk factors of hepatitis B virus (HBV) reactivation caused by anti-tuberculosis drugs in tuberculosis patients with HBsAg positive, and to further explore the preventive effect of entecavir on HBV reactivation after anti-tuberculosis treatment. Methods We retrospectively analyzed the relationship of factors such as age, sex, HBV-DNA load before treatment, history of long-term alcohol consumption, hypoalbuminemia and anti-HBV treatment of entecavir with HBV reactivation after anti-tuberculosis treatment in tuberculosis patients with HBsAg positive. And logistic regression analysis was performed on the factors with statistical significance. Results HBV reactivation occurred in 17 (23.61%) of 72 tuberculosis patients with HBsAg positive after anti-tuberculosis treatment. χ2 test revealed that there were statistically significant differences in age, HBV-DNA load before treatment, history of long-term alcohol consumption, hypoalbuminemia and anti-HBV treatment of entecavir between having and having no HBV reactivation (χ2=7.522, χ2=14.421, χ2=11.466, χ2=4.303, χ2=7.810, all P<0.05). Logistic regression analysis displayed that high level of HBV-DNA before treatment and history of long-term alcoholconsumption were independent risk factors for HBV reactivation after anti-tuberculosis treatment in the tuberculosis patients with HBsAg positive (OR=26.030, 95%CI: 2.402-282.115; OR=27.478, 95%CI: 1.777-424.891), while use of entecavir before anti-tuberculosis treatment was a protective factor for preventing HBV reactivation (OR=0.079, 95%CI: 0.008-0.830). Further analysis showed that the rates of HBV reactivation, liver function damage and forced termination of anti-tuberculosis treatment in the antiviral group using entecavir before anti-tuberculosis treatment were all significantly lower than those in the non-antiviral group (8.82% vs. 36.80%, 17.60% vs. 52.60%, 8.82% vs. 42.10%, all P<0.05). Conclusion High level of HBV-DNA and history of long-term alcohol consumption are independent risk factors for HBV reactivation after anti-tuberculosis treatment in the tuberculosis patients with HBsAg positive. Oral entecavir before anti-tuberculosis treatment can decrease the risk of HBV reactivation and reduce the occurrence of liver function damage.
[1] Chen L,Bao D,Gu L,et al.Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment[J].BMC Infect Dis,2018,18(1):295. [2] 中华医学会结核病学分会.抗结核药物性肝损伤诊治指南(2019年版)[J].中华结核和呼吸杂志,2019,42(5):343-356. [3] 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015更新版)[J].中华肝脏病杂志,2015,23(12):888-905. [4] Hwang JP, Lok AS. Management of patients with hepatitis B who require immunosuppressive therapy[J].Nat Rev Gastroenterol Hepatol,2014,11(4):209-219. [5] 中华医学会肝病学分会脂肪肝和酒精性肝病学组,中国医师协会脂肪性肝病专家委员会.酒精性肝病防治指南(2018更新版)[J].中华肝脏病杂志,2018,26(3):188-194. [6] Lee YH, Bae SC, Song GG. Hepatitis B virus (HBV) reactivation in rheumatic patients with hepatitis core antigen (HBV occult carriers) undergoing anti-tumor necrosis factor therapy[J]. Clin Exp Rheumatol,2013,31(1):118-121. [7] Dong HJ, Ni LN, Sheng GF, et al. Risk of hepatitis B virus (HBV) reactivation in non-Hodgkin lymphoma patients receiving rituximab-chemotherapy: a meta-analysis[J]. J Clin Virol,2013,57(3):209-214. [8] Yuen MF. Need to improve awareness and management of hepatitis B reactivation in patients receiving immunosuppressive therapy[J].Heptol Int,2016,10(1):102-105. [9] Wong GL, Yuen BW, Chan HL, et al. Impact of dose and duration of corticosteroid on the risk of hepatitis flare in patients with chronic hepatitis B[J]. Liver Int,2019,39(2):271-279. [10] 张梦阳,张硕,周宝桐,等.乙型肝炎病毒再激活及其预防性治疗[J].中华实验和临床感染病杂志(电子版),2017,11(1):4-9. [11] Pattullo V. Hepatitis B reactivation in the setting of chemotherapy and immunosuppression-prevention is better than cure[J].World J Hepatol,2015,7(7):954-967. [12] Williams R. Global challenges in liver disease[J].Hepatology,2006,44(3):521-526. [13] 李飞跃,申辉,杨华林,等.涂阳肺结核合并乙型肝炎流行病学分析[J].实用预防医学,2010,17(2):280-281.
2021, Vol. 28 
