261例结核患者抗痨药物所致不良反应及其危险因素分析  

Analysis of adverse reactions and related risk factors caused by anti-tuberculosis drugs in 261 tuberculosis patients

作　　者：李雪秋 李红秋 刘健雄[1] 刘国标[1] LI Xue-qiu;LI Hong-qiu;LIU Jian-xiong;LIU Guo-biao(Guangzhou Chest Hospital,Guangzhou,Guangdong 510095,China)

机构地区：[1]广州市胸科医院,广东广州510095

出　　处：《热带医学杂志》2020年第6期803-805,819,共4页Journal of Tropical Medicine

基　　金：广东省医学科研项目(A2016056)。

摘　　要：目的分析肺结核患者抗痨药物所致不良反应发生特征及其危险因素,为结核病防控提供依据。方法将2016年5月1日-2017年4月31日期间在广州市胸科医院使用标准化疗方案的初治涂阳或培阳肺结核患者作为研究对象,设计统一调查表,通过查阅病案资料及面对面问卷调查方式,收集其治疗期间不良反应发生情况及患者相关信息。采用单因素及多因素分析各研究因素对于不良反应发生结局的影响。结果共纳入研究261例,发生不良反应者189例,不良反应发生率为72.41%。不良反应类型主要为骨关节损害,发生率为55.94%(146/261),其次为肝功能损害和胃肠道反应,发生率分别为41.00%(107/261)和38.70%(101/261)。单因素分析显示,年龄、体质指数(BMI)、月收入、是否有肝病史、有无合并症及是否饮酒等因素的不良反应发生率的差异有统计学意义(P<0.05)。多因素分析显示,年龄>60岁(OR=3.19,95%CI:2.11~5.39)、低BMI(<18.5 kg/m2)(OR=1.40,95%CI:1.01~3.70)、肝病史(OR=1.89,95%CI:1.01~6.59)在回归方程中差异有统计学意义(P<0.05)。结论由抗结核药物引起的不良反应发生率较高,年老、营养不良、有肝病史可增加抗痨药物不良反应发生风险,临床诊疗过程中应加强危险因素早期识别,强化辅助治疗。Objective To study adverse reactions(ARs) and related risk factors caused by anti-tuberculosis drugs(ATDs)and provide evidence for prevention and control of tuberculosis(TB).Methods From May 1,2016 to April 31,2017,the TB patients with smear-positive or cultivate-positive who were treated with standardized therapy in Guangzhou Chest Hospital were enrolled as the subjects.The data on patients ’ ARs and personal information during treatment were collected using self-designed questionnaires by Consulting medical records and face-to-face interviewing.Univariate and multivariate analysis was used to analyze the impact of various research factors on the outcome of adverse reactions.Results A total of216 cases were enrolled,189 of which occurred ARs,yielding the incidence of 72.41%.The main type of ARs was injuries on bone and joint,with the incidence of 55.94%(146/261),followed by liver function damage and gastrointestinal reactions,with the incidence of 41.00%(107/261) and 38.70%(101/261),respectively.Univariate analysis showed that there were significant differences in age,BMI,monthly income,history of liver disease,complications and adverse drug reactions(P<0.05).Of which,age>60(OR=3.19,95%CI:2.11-5.39),BMI<18.5 kg/m^2(OR=1.40,95%CI:1.01-3.70)and history of liver disease(OR=1.89,95% CI:1.01-6.59) had statistical significance in multivariate regression equation(P<0.05).Conclusion The incidence of ARs caused by ATDs was high in Guangzhou.Old age,malnutrition and a history of liver disease could increase the risk of ADRs.Early identification of risk factors and intensive adjuvant therapy should be strengthened in clinical diagnosis and treatment.

关 键 词：肺结核 抗痨药物 不良反应 危险因素 

分 类 号：R521[医药卫生—内科学]