抗结核药物相关性肝功能衰竭34例临床特征  

Clinical features of anti-tuberculosis drug-induced liver failure:34 cases report

作　　者：戴炜[1] 禹弘[1] 王东[1] 邬明[1] 朱质斌[1] 赖慧仪[1] 

机构地区：[1]深圳市第三人民医院重症肝病区,518000

出　　处：《肝脏》2012年第6期389-390,共2页Chinese Hepatology

摘　　要：目的分析抗结核药物诱发肝功能衰竭的临床特征及相关影响因素。方法回顾性分析34例抗结核药物治疗期间出现肝功能衰竭的病例资料，按≤35岁、36～55岁及〉56岁3个年龄段进行临床特征及相关影响因素分析。采用χ^2检验进行统计分析。结果34例抗结核药物性肝功能衰竭中男15例，女19例，年龄14-68岁，平均（38．2±10．5）岁；病死率为67．6％（23／34），而超急性肝功能衰竭（2例）和急性肝功能衰竭（8例）中女性7例，病死8例；≥56岁者11例全部为亚急性肝功能衰竭，死亡9例，与≤55岁患者比较，差异有统计学意义（P〈0．01）。所有病例初始治疗为异烟肼、利福平、吡嗪酰胺联用，治疗至诊断为药物性肝功能衰竭（DILF）的时间为5～56d（平均23d）。34例中HBsAg阳性8例，3例HBsAg／抗-HBe阳性患者应用激素后1例HBeAg转为阳性，2例HBV DNA由低于检测下限出现高于检测下限；HBV血清标志物阳性者死亡率（6／8，75％）与阴性者死亡率（17／26，65．4％）比较，差异有统计学意义（P〈0．05）。结论抗结核药物诱发的超急性肝功能衰竭和急性肝功能衰竭可能与遗传多态性及机体较强的免疫状态相关；亚急性肝功能衰竭则可能与老年人药物在肝脏代谢能力的改变相关；激素有增加HBV复制的可能性，与肝功能衰竭的预后相关。Objective To analyze the clinical features and correlative factors of anti-tuberculosis drug-induced liver failure （DILF）. Methods Thirty-four cases of anti-tuberculosis DILF were retrospectively analyzed. The patients were divided into the young group （〈35 years old）, middle-aged group （36-55 years old） and aged group （〉56 years old）. Statistical analysis was performed by using SPSS 13.0. Results In the 34 cases, the ratio between male and female was 0.8 ： 1. The median age was 38.2 （ranging 14-68） years old and the total mortality was 67. 6%（23/34）. There were 2 cases of hyper-acute liver failure and 8 cases of acute liver failure. The incidence was higher in young women （7 out of 10）. The mortality was 80%. All of the aged were sub-acute liver failure. The mortality in aged group was higher than that in the young and middle aged groups （81.8% vs. 33.3%, P〈0.01）. All patients initially received the anti-tubercu- losis regimen of isoniazid, pyrazinamide and rifampin. The period from the initial treatment to drug-withdrawal in the oc- currence of DILF ranged from 5 to 56 days （average 23 days）. Ratio of serum HBsAg positive was 23.5% before treat- ment. In 3 cases with HBeAg negative, 1 case developed into HBeAg positive and 2 cases with HBV DNA below the limit of detection developed into HBV DNA positive after the treatment with glucocorticoid. The mortality of HBsAg carriers was higher than that of non-carriers （75% vs 65.4G ; P〈0.05）. Conclusion Hyper-acute liver failure or acute liver failure caused by anti-tuberculosis drugs was likely to be related to genetic polymorphism and human immune state. Sub- acute liver failure was likely related to the changes of liver pharmacokinetics in the old age. Glucocorticoid may enhanced HBV replication, which was related to the prognosis of liver failure.

关 键 词：抗结核药物 肝衰竭 乙型肝炎病毒 相关因素 

分 类 号：R575.3[医药卫生—消化系统]