耐药肺结核患者抗结核治疗肝损伤的临床治疗  

Liver injury in the drug resistant pulmonary tuberculosis patients during treatment

作　　者：聂思瑶 田文广[1] 万克强[1] 李伟[1] 

机构地区：[1]重庆医科大学附属永川医院感染科,重庆402160

出　　处：《西部医学》2017年第9期1285-1287,共3页Medical Journal of West China

基　　金：重庆医科大学附属永川医院科研项目(YJQN201326)

摘　　要：目的探讨耐药肺结核患者在抗结核治疗时出现肝损伤的主要原因及临床治疗。方法回顾性分析重庆医科大学附属永川医院感染科2011年1月~2016年1月收治82例耐药肺结核患者的临床资料,其中观察组15例患者抗结核治疗同时使用还原型谷胱甘肽片保肝治疗,对照组67例患者未使用保肝药,治疗8周后观察两组患者出现肝损伤例数,并分析其中肝损伤的原因。结果 82例患者中累计发生肝损伤23例(28.0%),观察组15例中和对照组67例中肝损伤发生率分别为2例(13.3%)和21例(31.3%),23例患者肝损伤进一步分析原因,其中合并慢乙肝、慢丙肝共8例,戊肝1例,自身免疫性肝炎1例,酒精性肝病3例。结论在抗结核治疗过程中耐药肺结核患者肝损伤发生率较高,常合并有乙肝、丙肝等病毒性肝炎,预防性使用保肝药可减少肝损伤的发生。Objective To investigate the main cause and clinical prevention strategies of liver injury in the drug resistant pulmonary tuberculosis patients during the antituberculosis treatment. Methods 82 drug resistant pulmonary tuberculosis patients in Yongchuan Hospital of Chongqing Medical University were retrospectively analyzed. The clinical data of the patients were observed. 15 patients in the preventive group were treated with reduced glutathione, 67 patients in the control group without reduced glutathione. The number and cause of liver injury shown in 82 patients were investigated for 8 weeks. Results Of all the 82 patients after antituberculosis treat, 23 patients （280%） shown liver injury. Of the 67 patients in the control group, 21 patients （313%） shown liver injury. While, of the 15 patients in the preventive group, only 2 patients（133%） of them suffered from liver injuryOf 23 patients with liver injury, 8 patients accompanied with chronic hepatitis B or C, 1 patient with acute hepatitis E, 1 patient with autoimmune hepatitis, and 3 patient with alcoholic liver disease. Conclusion The drug resistant pulmonary tuberculosis patients appeared high incidence of liver injury during the antituberculosis treatment. The drug resistant pulmonary tuberculosis patients should be received liverprotecting and considered that patients accompanied with chronic hepatitis B or C when liver injury.

关 键 词：耐药肺结核 肝损伤 原因 

分 类 号：R512.62[医药卫生—内科学]