肝硬度及血清肝纤维化指标对评估一线抗结核药物对肝功能损害的价值研究  

Evaluation value of liver stiffness combined with serum cirrhosis index on evaluating the liver damage caused by first-line anti tuberculosis drugs

作　　者：李劲[1] 罗银弟[1] 陈刘镇[1] 翟洁卿[1] LI Jin;LUO Yindi;CHEN Liuzhen;ZHAI Jieqing(Department of Infectious Diseases,the People’s Hospital of Dongguan City,Dongguan 523000,China)

机构地区：[1]广东省东莞市人民医院感染科,广东东莞523000

出　　处：《中国医药科学》2018年第13期21-26,共6页China Medicine And Pharmacy

基　　金：广东省东莞市医疗卫生科技计划一般项目(2016105101021)

摘　　要：目的探讨肝硬度检测及血清肝纤维化指标对评估一线抗结核药物(异烟肼、利福平、乙胺丁醇及吡嗪酰胺)对肝功能损害的价值。方法选择2016年1月~2017年8月在我科住院的初治肺结核患者300例,于治疗前进行肝硬度及血清肝纤维化指标的检测,根据肝硬度检测结果由轻到重分为F0-F1、F2、F2-F3、F3-F4、F4共5组,根据血清纤维化指标的结果分为正常组及异常组共两组,分别分析肝硬度指标及血清肝纤维化指标组间的治疗前后肝功能变化,然后进行上述两项指标对评估治疗后可能出现肝功能损害的价值研究。结果随着患者肝硬度的增加,使用一线抗结核药物后2周,出现肝功能损害的风险也随之增加(ALT、AST、TBIL、Γ-GGT的变化值越大);同时,血清肝硬化指标异常组的患者接受一线抗结核药物治疗2周后更容易出现肝功能损害,主要是肝脏胆管系统的炎症(P<0.05)。结论肝硬度值及血清肝硬化指标可作为评估肝脏的基础情况,从而用于评估初治肺结核患者接受一线抗结核药物治疗后出现肝功能损害风险有效指标。Objective To explore the evaluation value of liver stiffness combined with serum cirrhosis index on evaluating the liver damage caused by first-line anti tuberculosis drugs(isoniazide,rifampin,ethambutol and pyrazinamide).Methods From January 2016 to August 2017,300 cases of newly diagnosed pulmonary tuberculosis in our department were selected.Liver stiffness and serum cirrhosis index were detected in the treatment.According to the results of liver stiffness test,5 groups were divided into F0-F1,F2,F2-F3,F3-F4 and F4 from light to heavy.The results of serum fibrosis index were divided into two groups:the normal group and the abnormal group.The liver function changes before and after the treatment of liver fibrosis index were analyzed,and the value of the above two indexes to evaluate the possible damage of liver function after the treatment was evaluated.Meanwhile,all the patents were divided into two groups according to the serum cirrhosis index.The liver function changes including liver stiffness combined with serum cirrhosis index before and after the treatment were analyzed.Then the above two indexes were used to assess the possible value of liver function damage after treatment.Results With the increase of the patient's liver stiffness,the risk of liver function damage increased 2 weeks after the use of first-line anti TB drugs(the greater the change of ALT,AST,TBIL and gamma-GGT).Simultaneously,the patients in the abnormal liver cirrhosis index group were more prone to liver function damage after 2 weeks of first-line anti tuberculosis drug treatment,mainly inflammation of the liver bile duct system(P<0.05).Conclusion Liver stiffness measurement and the serum cirrhosis index can be taken for the liver basics,which could be regarded as the effective parameter to evaluate the possibility of anti-tuberculosis drug’s hepatotoxicity after antituberculosis therapy 2 weeks.

关 键 词：肝硬度 肝纤维化 Fibrotouch 一线抗结核药物 评估价值 

分 类 号：R521[医药卫生—内科学]