结核病患儿初次抗结核治疗致肝损害的临床分析  

Clinical analysis of the liver damage caused by first-time anti-tuberculosis treatment for children with tuberculosis

作　　者：任红梅[1] 杨雪[1] 吴颖[1] 李迎春[1] 田菲菲[1] 王影[2] 

机构地区：[1]沈阳市胸科医院结核四病房,沈阳110044 [2]中日友好医院中医消化科,北京100029

出　　处：《中国中西医结合儿科学》2016年第5期505-508,共4页Chinese Pediatrics of Integrated Traditional and Western Medicine

摘　　要：目的探讨初治结核病儿童应用抗结核药物出现肝功能异常的易发因素及治疗方法。方法 2008年3月至2014年5月在沈阳市胸科医院收治住院的初治结核病患儿中,应用异烟肼、利福平、吡嗪酰胺抗结核治疗后2周至3个月内出现肝损害36例。14例(38.89%)患儿有诱发肝损害的高危因素,其中患儿同时应用其他类药物12例,轻度营养不良1例,丙肝病毒携带者1例。分析36例临床资料,总结其临床特点、治疗方案、治疗转归。结果 36例结核病患儿,接受抗结核初治治疗方案后,均出现不同程度肝损害(急性肝炎型23例、急性瘀疸型5例、混合型8例)。予调整个体化抗结核治疗方案,停用可能致肝损害药物(阿奇霉素、红霉素、解热镇痛药、头孢类抗生素等)后,36例患儿均完成结核病治疗疗程,治愈结核病。结论诱发儿童肝损害的初治结核药物中以利福平、吡嗪酰胺为首。联合应用其他类药物治疗或伴营养不良、肝原有疾病等,会增加结核药致肝损害的风险。停用可能致肝损害药物,针对肝损害不同程度,予保肝治疗,选用异烟肼、利福喷丁、乙胺丁醇、链霉素等抗结核药物,予个体化抗结核治疗方案,以达到减轻患儿疾病痛苦,缩短疗程,治愈的目的。Objective To investigate the risk factors and treatment methods of liver dysfunction due to taking anti-tuberculosis for the first time in children with tuberculosis. Methods In the children who was admitted to Shenyang Chest Hospital from March of 2008 to May of 2014 and received first-time treatment for tuberculosis（TB） with isoniazid,rifampicin and pyrazinamide, 36 developed liver damage within 2 weeks to 3 months of treatment. Fourteen children（38.89%） had the risk factors, among whom 12 children took other drugs at the same time,one had mild malnutrition and one was hepatitis C Virus carrier. The clinical data of the 36 cases were analyzed to summarize the clinical features, treatment protocol and prognosis. Results All the 36 TB children developed liver damage of different degrees after first-time treatment（23 were acute hepatitis type,5 acute cholestasis type, 8 mixed type）. After the treatment protocol was adjusted and the drugs that might cause liver damage were s topped（azithromycin,erythromycin,analgesics and antipyretics,cephalosporin,etc. ） ,the 36 children completed the treatment course and were cured. Conclusion Rifampicin and pyrazinamide are the main drugs that induce liver damage in children receiving treatment for the first time. It may increase the risk of liver damage to use other drugs or if the children have malnutrition or have been with liver diseases before. The drugs should be stopped and give liver-protection treatment for different degrees of damage. Isoniazid, rifapentine, ethambutol and streptomycin can be used in the individualized anti-TB treatment to relieve the patientst pain and shorten treatment course,in order to cure the disease.

关 键 词：结核病 肝损害 利福平 吡嗪酰胺 儿童 

分 类 号：R529.9[医药卫生—内科学]