進階搜尋


 
系統識別號 U0026-0812200913553631
論文名稱(中文) B型和C型肝炎帶原是活動性結核病患服用第一線抗結核藥物後發生肝毒性之危險因子:統合分析
論文名稱(英文) Hepatitis B and C Virus Carriers Increase Risk for Active TB Patients with Hepatotoxicity by Taking the First-line Antituberculosis Drug: A Meta-analysis
校院名稱 成功大學
系所名稱(中) 公共衛生研究所
系所名稱(英) Graduate Institute of Public Health
學年度 95
學期 2
出版年 96
研究生(中文) 陳盈安
研究生(英文) Ying-An Chen
電子信箱 t8694106@mail.ncku.edu.tw
學號 t8694106
學位類別 碩士
語文別 中文
論文頁數 139頁
口試委員 口試委員-呂宗學
口試委員-簡順添
口試委員-王新台
指導教授-陳國東
中文關鍵字 rifampicin  isoniazid  肝毒性  C型肝炎  統合分析  B型肝炎  pyrazinamide 
英文關鍵字 rifampicin  pyrazinamide  isoniazid  hepatotoxicity  hepatitis C  hepatitis B  meta-analysis 
學科別分類
中文摘要 背景:第一線抗結核藥物INH、RMP、PZA皆有導致肝毒性的潛在風險,但是導致病人服藥後發生肝毒性之多數危險因子,包括B型肝炎、C型肝炎尚未有所定論。
目的:利用系統性文獻回顧與統合分析方法,探討B型、C型肝炎對於活動性結核病患服用第一線抗結核藥物後發生肝毒性的影響。
方法:根據2000年JAMA所刊登的Meta-analysis of Observational Studies in Epidemiology. A proposal for reporting.進行本研究統合分析的步驟。一共收集15個資料庫(如pubmed、EMBASE等),資料收尋年代為1990.01~2007.03年,語言為中文及英文文獻,納入符合研究主題,且可以提供計算相對危險性效果量的觀察性研究。
結果:B型肝炎帶原的活動性結核病患,服用第一線抗結核藥物後,ALT超過正常上限值、超過正常上限值3倍的肝毒性發生率分別為33.4%、28.1%;B型肝炎帶原者發生ALT>N、>2N、>3N的肝毒性風險,分別是非帶原者的2.922、2.987、3.595倍。C型肝炎帶原的活動性結核病患,在服用第一線抗結核藥物後,ALT超過正常上限值的發生率為36.4%,C型肝炎帶原者發生ALT>N、>2N、>3N的肝毒性風險,分別是非帶原者的4.030、3.875、2.716倍。
結論:B型肝炎帶原、C型肝炎帶原的確為活動性結核病患,服用第一線抗結核藥物後,發生肝毒性之危險因子。根據研究結果,建議每位結核病患在開始抗結核藥物治療前,應該先檢測B型、C型肝炎帶原狀態,針對此特定族群,治療時定期監測肝功能,以期及早發現並降低肝毒性的發生,增加結核病治療的安全性與完治率。
英文摘要 Background: The first-line antituberculosis drugs such as INH, RMP, PZA all have potential risk causing hepatotoxicity. Most of the risk factors for antituberculosis drugs-induced hepatotoxicity have not come to a conclusion yet, such as hepatitis B and hepatitis C.
Purpose: This study aimed to understand the effect of hepatitis B and hepatitis C on active patients with hepatotoxicity by taking the first-line antituberculosis drugs.
Method: The step of carrying on Meta-analysis of this study is according to the paper published of JAMA in 2000, Meta-analysis of Observational Studies in Epidemiology. Reports are extracted from 15 databases such as PubMed, EMBASE etc. Articles are the Chinese and English literatre and published between January, 1990 and March, 2007. The selection is further restricted by the observation study answer to this study purpose, and offer enough data to cauculate the effect size.
Result: The incidence of antituberculosis drug-induced hepatotoxicity (the ALT levels increased and increased more than 3 times upper limit of normal) in the active tuberculosis patient with hepatitis B is 33.4%, 28.1% respectively. And the odds ratio of hepatotoxicity, the ALT levels increased, more than the 2, and 3 times upper limit of normal, is 2.922, 2.987, and 3.595 respectively. The incidence of antituberculosis drug-induced hepatotoxicity (the ALT levels increased more than the upper limit of normal) in the active tuberculosis patient with hepatitis C is 36.4%. And the odds ratio of hepatotoxicity, the ALT levels increased, more than the 2, and 3 times upper limit of normal, is 4.030, 3.875, and 2.716 respectively.
Conclusion: hepatitis B and C are the risk factors for active patients with hepatotoxicity by taking the first-line antituberculosis drugs. According to our finding, we suggest that each active tuberculosis patient before beginning to resist tuberculosis drugs should test HBV and HCV. And aimed to the specific group, should monitor liver function regularly. Finding on time and reduce the hepatotoxiciy, increasing the therapeutical curing rate and safety.
論文目次 中文摘要 3
ABSTRACT 4
致謝 5
表目錄 8
圖目錄 10
第一章 緒論 12
第一節 研究動機及重要性 12
第二節 研究目的 14
第三節 研究問題 14
第三節 研究問題 15
第二章 文獻探討 15
第二章 文獻探討 16
第一節 結核病的治療原則 16
第二節 結核藥物引起的肝毒性 20
第三節 肝毒性發生之可能危險因子 27
第四節 使用抗結核藥物的肝功能監測 35
第三章 研究方法 36
第一節 研究族群與變項定義 36
第二節 資料搜尋與篩選 38
第三節 資料萃取及品質評估 41
第四節 效果量計算 43
第五節 資料分析 46
第四章 研究結果 47
第一節 研究基本資料 47
第二節 B型、C型肝炎且活動性結核病患者,服用第一線抗結核藥物後肝毒性之發生率 49
第三節 B型肝炎對活動性結核病患服用第一線抗結核藥物後發生肝毒性之影響 55
第四節 影響C型肝炎對活動性結核病患服用第一線抗結核藥物後發生肝毒性之影響 61
第五章 討論 65
第一節 納入之文獻品質 65
第二節 B型、C型肝炎且活動性結核病患者,服用第一線抗結核藥物後肝毒性之發生率 67
第三節 B型肝炎對活動性結核病患服用第一線抗結核藥物後發生肝毒性之影響 69
第四節 C型肝炎對活動性結核病患服用第一線抗結核藥物後發生肝毒性之影響 70
第五節 研究特色以及研究限制 71
第六章 結論與建議 72
參考文獻 73
附錄一、資料庫搜尋 117
附錄二、 編碼表 120
附錄三、 研究編號、名稱 123
附錄四、文獻基本資料表及摘要 124
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