抗结核药物所致脂肪肝的临床转归及影像学特征分析  

Clinical outcome and imaging characteristics of fatty liver caused by anti-tuberculosis drugs

作　　者：户彦龙[1] 梁长华[1] 窦文广[1] 李成海[2] 宁锋钢[2] 侯代伦 Hu Yanlong;Liang Changhua;Dou Wenguang;Li Chenghai;Ning Fenggang;Hou Dailun(Department of Radiology,the First Affiliated Hospital of Xinxiang Medical University,Henan Province 453100,China;Department of Radiology,Beijing Chest Hospital of Capital Medical University,Beijing 101149,China)

机构地区：[1]新乡医学院第一附属医院放射科,河南省453100 [2]首都医科大学附属北京胸科医院放射科,101149

出　　处：《中华传染病杂志》2020年第7期416-421,共6页Chinese Journal of Infectious Diseases

摘　　要：目的探讨初治药物敏感继发性肺结核患者标准化治疗过程中及治愈停药后肝脏密度变化的临床及影像学特征。方法采用回顾性分析,根据入组标准和排除标准纳入2014年1月至2019年4月首都医科大学附属北京胸科医院和新乡医学院第一附属医院收治的抗结核治疗过程中肝脏密度不同程度减低的继发性肺结核患者34例,治疗前行胸部计算机断层成像(computed tomography,CT)检查和痰菌培养。给予标准化治疗方案,根据3、9、12个月疗程分为3组,治疗3、6、9、12个月及治愈停药后3、6、12个月监测肝脏密度及肝功能指标变化情况。计量资料组间比较采用t检验。结果3组于治疗期肝脏平均密度逐渐降低,治愈停药后逐渐回升。6个月疗程组于治疗3、6个月分别有5例和9例脂肪肝,治愈停药后3、6、12个月分别有6、2、0例脂肪肝;9个月疗程组治疗3、6、9个月分别有4、8、11例脂肪肝,治愈停药后3、6、12个月分别有7、2、0例脂肪肝;12个月疗程组治疗3、6、9、12个月分别有5、10、14、14例脂肪肝,治愈停药后3、6、12个月分别有12、10、5例脂肪肝。在治疗过程中部分肝脏密度出现不均匀减低,治疗6、9、12个月及停药后3、6个月肝左叶密度分别为(49.8±4.0)、(45.0±3.9)、(37.0±9.9)、(45.3±8.1)、(48.4±6.6)HU,肝右叶密度分别为(44.0±6.1)、(37.2±7.7)、(25.5±15.8)、(38.5±11.7)、(43.8±9.9)HU,差异均有统计学意义(t=4.611、4.512、2.307、2.803、2.291,均P<0.05),治疗3个月及停药后12个月差异均无统计学意义(t=1.573、1.199,均P>0.05)。各有2例患者的丙氨酸转氨酶和天冬氨酸转氨酶于治疗3、6个月升高(丙氨酸转氨酶>2倍正常值上限,天冬氨酸转氨酶<2倍正常值上限),碱性磷酸酶和总胆红素均未检测出异常。结论抗结核治疗过程中肝脏密度逐渐减低并出现不均匀脂肪肝,而停药后逐渐恢复正常或减轻,脂肪肝程度与肝功能指标(�Objective To investigate the clinical and imaging characteristics of liver density changes in patients with initial-treated drug-sensitive secondary tuberculosis during standardized treatment and after withdrawal when cured.Methods A retrospective analysis was conducted of 34 patients with initial-treated drug sensitive pulmonary tuberculosis in Beijing Chest Hospital of Capital Medical University and the First Affiliated Hospital of Xinxiang Medical University from January 2014 to April 2019.The chest computed tomography(CT)examination and sputum culture were performed before treatment.The patients received the standardized treatment and they were divided into three groups according to the course of treatment(three,nine and 12 months).Liver density and liver function were followed up during treatment(three,six,nine and 12 months)and after drug withdrawal(3,6 and 12 months).The measurement data were analyzed by t-test.Results The average liver density of these three groups gradually decreased during the treatment period,and gradually increased after drug withdrawal.There were five and nine cases of fatty liver occurred at three and six months of treatment in the six-month treatment group,respectively;and six,two and zero cases of fatty liver occurred at three,six,and 12 months after drug withdrawal,respectively.There were four,eight and 11 cases of fatty liver occurred at three,six,and nine months of treatment in the nine-month treatment group,respectively;and seven,two and zero cases occurred at three,six,and 12 months after drug withdrawal,respectively.There were five,10,14 and 14 cases of fatty liver occurred at three,six,nine and 12 months of treatment in the 12-month treatment group,respectively;and 12,10 and five cases occurred at three,six,and 12 months after drug withdrawal,respectively.During the course of treatment,the density of livers of some cases decreased unevenly,and the density of right lobe of the liver was lower than the left lobe.The density of left lobe of the liver was(49.8±4.0)HU,(45.0±3.

关 键 词：结核 肺 药物性肝损伤 脂肪肝 临床转归 计算机断层成像 

分 类 号：R521[医药卫生—内科学]