抗结核药物导致肝损伤的发生率及相关影响因素分析  

Incidence and Influencing Factors of Liver Injury in Patients Taking Anti-Tuberculosis Drugs

作　　者：吴丽娟 郭旭君 黄垚 刘瑶瑶 白俊博 刘盛元 WU Li-juan;GUO Xu-jun;HUANG Yao;LIU Yao-yao;BAI Jun-bo;LIU Sheng-yuan(Shenzhen Nanshan Center for Chronic Disease Control,Shenzhen 518000,China)

机构地区：[1]深圳市南山区慢性病防治院,深圳518000

出　　处：《伤害医学(电子版)》2024年第4期17-24,共8页Injury Medicine(Electronic Edition)

基　　金：南山区科技计划项目(医疗卫生类)(NS2024036,NS2022065)。

摘　　要：目的了解深圳市南山区结核病患者抗结核治疗中出现肝损伤的发生状况及影响因素,为制定科学合理的抗结核药物诱导的肝损伤(anti-tuberculosis drug-induced liver injury,ATB-DILI)防治策略提供依据。方法选取2019年1月—2023年12月在深圳市南山区慢性病防治院门诊登记治疗的结核病患者,统计肝损伤的发生率,根据是否发生肝损伤将患者分为观察组和对照组,收集两组患者的一般人口学信息、临床特征、实验室检查结果等并进行比较,对肝损伤的相关影响因素进行多因素logistic回归分析。结果1064例患者经抗结核药物治疗,发生肝损伤的比例26.97%,其中,ATB-DILI的发生率是10.71%;76.31%的患者在抗结核治疗前2个月内发生肝损伤;多因素logistic回归分析显示,糖尿病、ALT基线水平与肝损伤的发生存在相关性(OR=1.654,95%CI=1.131~2.419,P<0.05;OR=1.073,95%CI=1.061~1.084,P<0.01)。结论糖尿病、ALT基线水平可能是抗结核药物性肝损伤的影响因素,合理控制血糖、密切监测ALT基线变化有助于减少肝损伤的发生。Objective To investigate the occurrence and influencing factors of liver injury in patients with anti-tuberculosis treatment in Nanshan District,Shenzhen,and to provide a basis for formulating prevention and treatment strategies.Methods From January 2019 to December 2023,patients with tuberculosis who were registered and treated at the outpatient clinic of the Shenzhen Nanshan Center for Chronic Disease Control were selected.The incidence of liver injury was calculated.These patients were divided into an observation group and a control group based on whether they developed liver injury.For the two groups,their general demographic information,clinical characteristics,and laboratory test results were compared.Multivariate logistic regression analysis was conducted to identify the relevant factors influencing liver injury.Results Among the 1064 patients treated with anti-tuberculosis drugs,the proportion of those who developed liver injury was 26.97%,with the incidence of ATB-DILI being 10.71%.Notably,76.31%of the patients developed liver injury within the first 2 months of anti-tuberculosis treatment.Multivariate logistic regression analysis showed that diabetes and baseline ALT levels were correlated with the occurrence of injury(0R=1.654,95%CI-1.131-2.419,P<0.05;OR-1.073,95%CI-1.061-1.084,P<0.01).Conclusion:Diabetes and baseline ALT levels may be contributing factors for drug-induced liver injury during antituberculosis treatment,achieving reasonable glycemic control and closely monitoring changes in baseline ALT levels can help to reduce the incidence of liver injury.

关 键 词：抗结核治疗 肝损伤 肝功能异常 

分 类 号：R52[医药卫生—内科学]