抗结核治疗致肺结核患者药物性肝损伤的危险因素分析  

Risk Factors of Drug-induced Hepatic Injury in Tuberculosis Patients after Anti-tuberculosis Therapy

作　　者：刘芳[1] 臧珊珊 刘永梅[2] 田贞贞 马金彤 张桂珍[1] 吕侯强[3] 王英超 LIU Fang;ZANG Shan-shan;LIU Yong-mei;TIAN Zhen-zhen;MA Jin-tong;ZHANG Gui-zhen;LYU Hou-qiang;WANG Ying-chao(Department of Tuberculosis,Baoding Infectious Diseases Hospital,Hebei Baoding 071000;Department of Hepatology,Baoding Infectious Diseases Hospital,Baoding,Hebei,071000;Department of Respiratory Medicine,the Second Hospital of Shijiazhuang,Shijiazhuang 050000,China;Department of Internal Medicine,Baoding Hospital of Diabetes Mellitus,Baoding,Hebei 071000,China)

机构地区：[1]保定市传染病医院结核科,河北保定071000 [2]保定市传染病医院肝病科,河北保定071000 [3]石家庄市第二医院呼吸内科,石家庄050000 [4]保定市糖尿病医院内科,河北保定071000

出　　处：《解放军医药杂志》2019年第9期56-59,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省卫生厅科研基金项目(20181037);保定市科技局科技支撑计划项目(18ZF112)

摘　　要：目的分析抗结核治疗肺结核患者发生药物性肝损伤(DILD)的危险因素。方法选取2015年1月-2018年12月收治的抗结核治疗肺结核患者513例。统计所有患者的一般资料,包括性别、年龄、吸烟、饮酒情况;疾病史以及治疗情况,包括糖尿病史、肝脏病史、治疗方案(初治、复治、耐多药结核病治疗方案)、保肝药物使用情况、营养状况等。采用多因素Logistic回归分析方法分析相关危险因素。结果本组抗结核治疗的肺结核患者中共发生DILD 82例,发生率为15.98%。经多因素Logistic回归分析结果显示,年龄≥40岁、有肝脏病史、酗酒、营养不良以及未使用保肝药物是抗结核治疗肺结核患者发生DILD的独立危险因素(P<0.05)。结论抗结核治疗肺结核患者发生DILD的危险因素复杂,应对高危因素进行综合评估,早发现、早预防,准确预测,采取针对性措施,避免DILD的发生或减轻对肝脏的损伤程度。Objective To analyze risk factors of drug-induced hepatic injury(DIHI)in tuberculosis patients after anti-tuberculosis therapy.Methods A total of 513 tuberculosis patients undergoing anti-tuberculosis therapy during January 2015 and December 2018 were recruited in this study.General data such as gender,age,smoking and alcohol consumption,and case history and therapy conditions such as history of diabetes mellitus and liver disease,treatment protocols(initial treatment,retreatment,multi-drug resistant tuberculosis treatment),use of hepatoprotective drugs and nutritional status were collected.Multivariate logistic regression analysis was used to analyze the related risk factors.Results There were 82 tuberculosis patients with DIHI,and incidence rate was 15.98%.Multivariate logistic regression analysis showed that age equal or more than 40 years old,having history of liver disease,alcoholism,malnutrition and non-use of hepatoprotective drugs were independent risk factors for DIHI in tuberculosis patients undergoing anti-tuberculosis therapy(P<0.05).Conclusion Risk factors of DIHI in tuberculosis patients undergoing anti-tuberculosis are complex.Comprehensive evaluation should be carried out for high risk factors,early detection,and early discovery and prevention,accurate prediction and targeted measures should be taken to avoid DIHI pathogenesy or reduce degree of hepatic injury.

关 键 词：结核 肺 药物性肝损伤 危险因素 抗结核药 

分 类 号：R521[医药卫生—内科学]