慢性HBV感染者抗结核药所致肝损伤的临床特点及预后影响因素  

Research on the clinical characteristics and the prognostic influencing factors of the anti-tuberculosis drug induced liver injury in patients with chronic HBV infection

作　　者：张婧[1] 何雪兰 谭俊[1] ZHANG Jing;HE Xue-lan;TAN Jun(Department of Pharmacy,Guangzhou Eighth People's Hospital,Guangdong Guangzhou 510060, China)

机构地区：[1]广州市第八人民医院药剂科,广东广州510060

出　　处：《中国医院药学杂志》2018年第24期2584-2587,共4页Chinese Journal of Hospital Pharmacy

摘　　要：目的:探讨慢性乙肝病毒(HBV)感染者抗结核药所致肝损伤的临床特点及预后影响因素,为该类患者安全合理使用抗结核药物提供理论依据。方法:采用回顾性分析,将某院2011年9月至2017年8月收治的抗结核药所致肝损伤的住院患者分为对照组(非HBV感染者)及观察组(HBV感染者),对患者一般情况、病史、症状、体征和实验室检查进行统计,并对观察组的临床转归进行影响因素分析。结果:观察组男性患者比例较高,起病时间、TBil、ALT、PTA、INR、Hb、糖尿病及肝硬化病史存在差异(P<0.05)。2组患者肝损伤的临床分型均以肝细胞型为主(P>0.05),但观察组患者严重程度更高且预后不佳者较多(P<0.05)。INR(OR=5.91,95%CI 2.113～16.531)和并发症数量(OR=2.543,95%CI 1.552～4.167)是影响观察组患者预后的独立预测因子。结论:慢性HBV感染者抗结核药所致肝损伤多见于男性患者,服药后起病时间较长、并发症多,常可导致重度肝损害或肝衰竭,且预后不佳。入院时INR水平和治疗期间并发症数量可预测患者的临床转归。OBJECTIVE To investigate the clinical characteristics and the prognostic influencing factors of the anti-tuberculo-sis drug induced liver injury in patients with chronic hepatitis B virus(HBV)infection,and provide data for safe and rational use of anti-tuberculosis drug in these people.METHODS A retrospective analysis was employed using the data from September 2011to August 2017.The inpatients with anti-tuberculosis drug induced liver injury were divided into control group(non-HBV infections)and observation group(HBV infections).The general conditions,medical histories,signs and symptoms,and labo-ratory studies of two groups were analyzed,and the prognostic influencing factors analysis was investigated in observation group.RESULTS Observation group had higher percentage of males.The time of onset,TBil,ALT,PTA,INR,Hb,histo-ries of diabetes and cirrhosis were different to some extent(P <0.05).The distribution of liver cell type in two groups had no statistically significant differences(P >0.05).The severities of liver injures and the poor prognosis of the observation group were more than those of the control group(P <0.05).INR(OR=5.91,95% CI 2.113-16.531)and the number of complica-tions(OR=2.543,95% CI 1.552-4.167)were independent predictors of prognosis in observation group.CONCLUSION The anti-tuberculosis drug induced liver injury in patients with HBV infection are mainly male,with longer time of onset after administration and more complications,the clinical outcomes can sometimes be severe liver injury or even liver failure with poor prognosis.INR at admission and the number of complications during treatment can predict the clinical outcomes.

关 键 词：HBV 抗结核药 肝损伤 临床特点 预后 

分 类 号：R974[医药卫生—药品]