抗结核药物性肝损伤临床危险因素分析  

Analysis of clinical risk factors associated with anti-tuberculosis drug-inducing liver injury

作　　者：卫安娜[1] 方怡[1] 梁国添[1] 余燕华[1] 邝浩斌[1] 温文沛[1] 

机构地区：[1]广州市胸科医院,广东广州510095

出　　处：《临床肺科杂志》2015年第9期1556-1559,共4页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析肺结核化疗中发生抗结核药物性肝损伤(ATLI)的临床危险因素。方法收集2013年1月到2014年7月期间在我院住院治疗的肺结核合并抗结核药物性肝损伤病例100例为观察组,随机抽取同一时间段在我院住院治疗的肺结核无合并抗结核药物性肝损伤病例100例为对照组,采用回顾性病例对照研究的方法,用Logistic多因素回归分析法对所有的病例肺结核病的初/复治、肺结核病变范围、痰涂片找结核菌情况,合并肺外结核、乙肝表面抗原携带者、嗜酒史、原有除乙肝外的其它肝病史、糖尿病、呼吸衰竭、心功能不全、低蛋白血症、贫血共12个因素进行统计学处理,分析影响抗结核药物性肝损伤的危险因素。结果 Logistic多因素回归分析显示抗结核药物性肝损伤的危险因素包括乙肝表面抗原携带者(OR=3.113、P=0.005)、嗜酒史(OR=3.427、P=0.008)、原有除乙肝外的其它肝病史(OR=2.359、P=0.032)、呼吸衰竭(OR=1.622、P=0.045)、心功能不全(OR=1.700、P=0.015)、低蛋白血症(OR=1.860、P=0.012)和贫血(OR=1.718、P=0.014)等7项。结论乙肝表面抗原携带者、嗜酒史、原有除乙肝外的其它肝病史、呼吸衰竭、心功能不全、低蛋白血症和贫血是抗结核药物性肝损伤的危险因素。Objective To analyze the clinical risk factors associated with anti-tuberculosis drug-inducing liv-er injury （ATLI）. Methods From 2013 January to 2014 July, a total of 100 pulmonary tuberculosis patients com-plicated with ATLI were enrolled as the case group, and 100 patients only with pulmonary tuberculosis were randomly selected as the control group. The retrospective case-control study and multivariate logistic regression were used to an-alyze the risk factor associated with liver injury caused by anti-tuberculosis therapy. The factors for analysis included initial/ retreated pulmonary tuberculosis cases, range, sputum smear positive, whether complicated with extra pulmo-nary tuberculosis lesions, hepatitis B surface antigen carriers, alcohol abuse, history of hepatitis diseases besides hepatitis B, diabetes, heart function incomplete, respiratory failure, hypoproteinemia, and anemia. Results The results of multivariate logistic regression analysis showed that the risk factors included hepatitis B surface antigen car-riers （OR = 3. 113, P = 0. 005）, history of alcoholism （OR = 3. 427, P = 0. 008）, history of the other hepatitis dis-eases besides hepatitis B （OR = 2. 359, P = 0. 032）, respiratory failure （OR = 1. 622, P = 0. 045）, cardiac func-tional insufficiency （OR = 1. 700, P = 0. 015）, hypoproteinemia （ OR = 1. 860, P = 0. 012） and anemia （ OR =1. 718, P = 0. 014）. Conclusion The risk factors for liver injury caused by anti tuberculosis drugs include hepatitis B surface antigen carriers, history of alcoholism, history of hepatitis diseases besides hepatitis B, respiratory failure, cardiac functional insufficiency, hypoproteinemia and anemia.

关 键 词：结核/ 肺 肝损 病例对照 危险因素 

分 类 号：R521[医药卫生—内科学]