抗结核药物致药物性肝损伤患者临床特点及其危险因素分析*

doi:10.3969/j.issn.1672-5069.2020.01.017

摘要/Abstract

摘要： 目的分析抗结核药物治疗致药物性肝损伤(DILI)患者的临床特点及其发生的危险因素。方法回顾性分析我院诊治的接受抗结核治疗的558例结核病患者的病历资料,发生DILI 69例,未发生489例。应用Logistic回归分析影响患者发病的因素。结果在558例结核病患者抗痨过程中,发生DILI患者69例(12.4%);在442例初治结核患者中,发生DILI 24例(5.4%),在103例复治结核患者中发生DILI 37例(35.9%),在13例耐多药结核患者中发生DILI 8例(61.5%,P<0.05);69例DILI患者血清ALT、AST、TBIL、GGT和AKP峰值水平分别为152.1±9.6 U/L、174.8±15.4 U/L、94.8±8.6μmol/L、131.3±10.2 U/L和152.0±14.3 U/L;不同年龄、肝病史、酗酒史和抗结核治疗时机患者DILI发生率显著不同,而既往有肝病史、复治结核和耐多药肺结核是发生DILI的独立危险因素(P<0.05)。结论复治或耐多药抗结核药物的患者容易发生DILI,了解这类人群发生DILI的诱发因素,及时控制和做好保护工作,对完成抗结核方案,取得治疗效果非常重要。

关键词: 药物性肝损伤, 抗结核治疗, 耐多药, 复治, 危险因素

Abstract: Objective The aim of this study was to summarize the clinical characteristics and analyze the risk factors of drug-induced liver injury(DILI) caused by antituberculosis therapy. Methods 558 patients receiving antituberculosis therapy in our hospital were retrospectively analyzed in this study, and 69 patients had DILI. The incidences and laboratory indexes of patients with different antituberculosis regimen were compared and the risk factors affecting the incidence of DILI were determined by Logistic analysis. Results During the anti-tuberculosis process, 69 (12.4%) out of 558 patients with tuberculosis developed DILI; out of 442 nave patients, the incidence of DILI was 5.4%, much lower than 35.9% in 103 relapse patients or 61.5% (P<0.05) in 13 patients with multi-drug resistance (MDR); serum alanine aminotransferase, aspartate aminotransferase, total bilirubin, glutamyltranspeptidase and alkaline phosphatase peak levels in the 69 patients with DILI were 152.1±9.6 U/L, 174.8±15.4 U/L, 94.8±8.6μmol/L, 131.3±10.2 U/L and 152.0±14.3 U/L; the incidences of DILI in patients with different age, liver disease history, alcohol abuse and anti-tuberculosis regimen were significantly different and liver disease history, relapse and patients with MDR were the independent risk factors for DILI occurrence (P<0.05). Conclusion The incidence rate of DILI is different in patients with different anti-tuberculosis treatment, and the clinicians must take the risk factors into consideration in order to avoid the harmful elements and protect the patients to finish the anti-tuberculosis regimen.

Key words: Drug-induced liver injury, Anti-tuberculosis therapy, Multiple drug resistant, Relapse, Risk factors

王建辉, 郭红丹, 孔晶晶, 武希润. 抗结核药物致药物性肝损伤患者临床特点及其危险因素分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 58-61.

Wang Jianhui, Guo Hongdan, Kong Jingjing, et al. Clinical characteristics and risk factors ofdrug-induced liver injury caused by antituberculosis therapy[J]. Journal of Practical Hepatology, 2020, 23(1): 58-61.

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抗结核药物致药物性肝损伤患者临床特点及其危险因素分析^*

Clinical characteristics and risk factors ofdrug-induced liver injury caused by antituberculosis therapy

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