一线抗结核药物致肺结核患者药物性肝损伤发生情况分析  

Incidence of Drug-Induced Liver Injury in Patients with Pulmonary Tuberculosis Caused by First-Line Anti-Tuberculosis Drugs

作　　者：陶磊[1] 陈庆[1] 祝建峰[1] TAO Lei;CHEN Qing;ZHU Jianfeng(Hebei Chest Hospital,Shijiazhuang,Hebei,China 050041)

机构地区：[1]河北省胸科医院,河北石家庄050041

出　　处：《中国药业》2020年第16期70-72,共3页China Pharmaceuticals

基　　金：河北省医学科学研究重点课题[20160490]。

摘　　要：目的探讨一线抗结核药物所致肺结核伴乙型肝炎(简称乙肝)患者药物性肝损伤的发生情况。方法选取医院2015年1月至2017年11月收治的肺结核患者142例,将44例乙肝病毒脱氧核糖核酸(HBV-DNA)≥103 copies/m L的乙肝肝炎表面抗原(HBsAg)阳性患者作为A组,56例HBV-DNA <103copies/m L的HBsAg阳性患者作为B组,42例HBsAg阴性患者作为C组。3组患者均执行2HRZS(E)/4HR结核治疗方案,观察用药期间药物性肝损伤发生情况。结果 A组和B组患者治疗后肝损伤发生率分别为45.45%和33.93%,明显高于C组的9.52%(P <0.05),A组和B组相当(P>0.05);治疗后,各组的丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、结合胆红素(DBil)水平均明显高于治疗前,且A组和B组均明显高于C组(P <0.05),而A组ALT水平明显高于B组(P <0.05)。结论肺结核合并HBV-DNA阳性患者临床发生药物性肝损伤的概率较高,临床需密切监测其肝功能,及时调整治疗方案,合理使用保肝药物。Objective To explore the incidence of drug-induced liver injury in patients with tuberculosis and hepatitis B caused by first-line anti-tuberculosis drugs. Methods A total of 142 cases of tuberculosis patients treated in the hospital from January 2015 to November 2017 were selected. According to the hepatitis B surface antigen,44 cases were included in group A( hepatitis B virus DNA≥103 cps/m L),56 cases were included in group B( hepatitis B virus DNA < 103 cps/m L),and 42 hepatitis B surface antigen( HBsAg)negative patients were included as group C. All patients were treated with 2 HRZS( E)/4 HR for tuberculosis,and the incidence of drug-induced liver injuery in the three groups was observed. Results The incidence of liver injury in groups A and B after treatment were 45. 45% and 33. 93%,which were significantly higher than 9. 52% in group C( P < 0. 05),and the incidence in group A and group B were similar( P > 0. 05). After treatment,the levels of alanine aminotransferase( ALT),total bilirubin( TBil),and conjugated bilirubin( DBil) in each group were significantly higher than those before treatment,and the levels in groups A and B were significantly higher than those of group C( P < 0. 05),while the ALT level of group A was significantly higher than that of group B( P < 0. 05).Conclusion Patients with pulmonary tuberculosis and HBV-DNA positive are more likely to develop drug-induced liver injury in the clinical practice. We should conduct close clinical monitoring of their liver function,timely adjust the treatment plans,and rationally use the liver protection drugs.

关 键 词：一线抗结核药物 药物性肝损伤 乙型肝炎病毒脱氧核糖核酸 肝功能监测 药学服务 

分 类 号：R969.4[医药卫生—药理学] R978.7[医药卫生—药学]