耐药肺结核患者发生药物性肝损伤的危险因素分析  

Analysis of risk factors for the occurrence of drug-induced liver injury in patients with drug-resistant pulmonary tuberculosis

作　　者：孔君 牛玉兰 黄艳[1] 刘裔 杨燕 李学祺 张向荣 KONG Jun;NIU Yulan;HUANG Yan;LIU Yi;YANG Yan;LI Xueqi;ZHANG Xiangrong(Department of Tuberculosis,the Second Hospital of Nanjing,Nanjing,Jiangsu 211131,China)

机构地区：[1]南京市第二医院结核科,江苏南京211131

出　　处：《医学动物防制》2025年第3期304-308,共5页Journal of Medical Pest Control

基　　金：国家“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项“十三五”项目——耐药肺结核中医药治疗新方案研究(2018ZX10725-509);江苏省卫生健康委科研项目(Z2023046)。

摘　　要：目的探讨耐药肺结核(drug-resistant pulmonary tuberculosis,DR-PTB)患者抗结核治疗过程中发生药物性肝损伤(drug induced liver injury,DILI)的危险因素,为DR-PTB患者选择更安全有效的治疗方案提供参考依据。方法2021年1月—2022年12月选取241例DR-PTB患者为研究对象,根据是否发生DILI分为DILI组(45例)和非DILI组(196例),采用多因素logistic回归分析DILI的危险因素,并通过受试者操作特征(receiver operating characteristic,ROC)曲线分析其对DILI的预测价值。结果DR-PTB患者DILI发生率为18.67%。多因素logistic回归分析显示,年龄≥60岁(OR=4.648,95%CI:1.840~11.739)、白蛋白<35g/L(OR=11.053,95%CI:4.619~26.452)、治疗方案含吡嗪酰胺(OR=8.005,95%CI:2.706~23.680)及合并慢性乙型肝炎病毒(HBV)感染(OR=15.766,95%CI:4.060~61.224)为DILI的独立危险因素(均P<0.05)。联合4项指标预测DILI的曲线下面积(area under the curve,AUC)为0.911,优于单项指标。结论临床需重点关注高龄、营养不良、治疗方案含吡嗪酰胺及合并慢性HBV感染的DR-PTB患者,警惕DILI的发生。Objective To investigate the risk factors of drug-induced liver injury(DILI)in patients with drug-resistant pulmonary tuberculosis(DR-PTB)during anti-tuberculosis treatment,and to provide a reference bases for the selection of safer and more effective treatment regimens for DR-PTB patients.Methods From January 2021 to December 2022,a total of 241 DR-PTB patients were selected as the research objects,and were divided into DILI group(45 cases)and non-DILI group(196 cases)according to whether DILI occurred or not.Multifactorial logistic regression analysis was used to analyze the risk factors of DILI.The receiver operating characteristic(ROC)curve was used to analyze its predictive value for DILI.Results The incidence rate of DILI in DR-PTB patients was 18.67%.Multifactorial logistic regression analysis showed that age≥60 years(OR=4.648,95%CI:1.840-11.739),albumin<35g/L(OR=11.053,95%CI:4.619-26.452),treatment regimen included pyrazinamide(OR=8.005,95%CI:2.706-23.680)and comorbid chronic Hepatitis B virus infection(OR=15.766,95%CI:4.060-61.224)were independent risk factors for DILI(all P<0.05).The area under the curve(AUC)of combining the four indicators to predict DILI was 0.911,which was better than that of each single index.Conclusion Clinical attention should be focused on DR-PTB patients with advanced age,malnutrition,pyrazinamide treatment and comorbid chronic HBV infection to be alert to the occurrence of DILI.

关 键 词：耐药肺结核 利福平耐药 DILI 危险因素 回归分析 受试者操作特征曲线 

分 类 号：R521[医药卫生—内科学]