初治肺结核患者药物性肝损伤的危险因素分析及对策  

Risk factors and strategies of drug-induced liver injury in untreated pulmonary tuberculosis patients

作　　者：毛佳斌[1] 孙培英[1] 徐金田[1] 

机构地区：[1]杭州师范大学附属医院结核科,浙江杭州310015

出　　处：《中华全科医学》2016年第11期1867-1869,共3页Chinese Journal of General Practice

摘　　要：目的统计初治肺结核患者药物性肝损伤(drug-induced liver injury,DILI)的发生率,并分析患者发生肝损伤的危险致病因素。方法回顾性分析杭州师范大学附属医院2013年1月—2015年12月间收治且行抗结核药物治疗的620例肺结核病患者病例资料。根据有无发生肝损伤,将其分为有肝损伤组(117例)和无肝损伤组(503例)。制作危险因素调查表,收集性别、病程、年龄、饮酒史、吸烟史、肝炎史、糖尿病、血压水平、身体质量指数、保肝药服用等资料,采用单因素和Logistic回归分析对相关危险因素进行分析。结果肝损伤的发生率为18.9%。单因素分析结果显示:高龄、饮酒、吸烟、Hbs Ag阳性、高血糖、高血压、身体质量指数、未服用保肝药是初治肺结核患者发生DILI的危险因素。多因素Logistic回归分析结果显示:高龄、饮酒、吸烟、Hbs Ag阳性、高血糖、高血压、身体质量指数、未服用保肝药是初治肺结核患者发生DILI的危险因素。结论初治肺结核患者临床服用抗结核药物后,易发生DILI,而高龄、饮酒、吸烟、Hbs Ag阳性、糖尿病、高血压、身体质量指数、未服用保肝药是患者发生DILI的危险因素,应对这些因素进行高度重视,并给予个性化防治。Objective To account the incidence of drug-induced liver injury （DILI） in untreated pulmonary tuberculosis patients,and investigate the risk factors of drug-induced liver injury. Methods All 620 cases of pulmonary tuberculosis patients in our hospital from January,2013 to December,2015 were retrospectively analyzed. The patients were divided in- to injury group（ 117 cases） and uon-injury group （503 cases）based on drug-induced liver injury. The risk factors ques- tionnaire included the h^llowing items ： factors of gender, disease duration, age, drinking history, smoking history, HbsAg positive, diabetes, blood pressure level, Body mass index, using of protection liver drug. Univariate factor and Logistic re- gression analysis were calTied out to analyze the related risk factors. Results The liver damage rate was 18.9%. Univari- ate analysis showed that the age, drinking history, smoking history, HbsAg positive, diabetes, blood pressure level, Body mass index, non-using of protection liver drug were the risk factors of DILl of pulmonary tuberculosis. And multivariate Lo- gistic regression analysis showed that the age, drinking history, smoking history, HbsAg positive, diabetes, blood pressure level, Body mass index, non-using of protection liver drug were the risk factors of DILl of pulmonary tuberculosis. Conclusion Treatment naive patients with pulmonary tuberculosis easily occur DILl after the application of anti-TB drugs, and age,drinking history, smoking history, HbsAg positive, diabetes, blood pressure level, Body mass index, non-using of protection liver drug were the risk factors of drug-induced liver injury. These risk factors should be paid more attention.

关 键 词：肺结核 抗结核药物 肝损伤 危险因素 

分 类 号：R521[医药卫生—内科学] R978.3[医药卫生—临床医学]