1501例初治住院结核病患者肝功能异常的影响因素

Influencing factor of liver dysfunction of inpatients of tuberculosis with initial treatment

目的探讨初治住院结核病患者出现肝功能异常的影响因素。方法采用回顾性研究,以2016年1月至2018年12月云南省解放军第九二〇医院和玉溪市人民医院感染性疾病科初治住院结核病患者为研究对象,收集和分析患者的人口学资料和肝功能指标。结果在纳入分析的1501例患者中,44.4%(669/1501)患者住院期间伴有肝功能异常,3.9%(59/1501)患者达到药物性肝损伤(DILI)的诊断标准。引发肝功能异常的原因包括抗结核药物诱发的肝功能损伤(48.3%、323/669)、非抗结核药物诱发的肝功能损伤(36.9%、247/669)、基础肝病诱发的肝功能损伤(3.1%、21/669)和不明原因诱发的肝功能损伤(11.7%、78/669);其中导致肝功能异常的前3位非抗结核药物为抗菌药物(15.7%、105/669)、解热镇痛药(7.5%、50/669)和中草药(7.5%、50/669)。导致结核病患者发生DILI的前3位药物是抗结核药(72.8%、43/59)、中草药(15.3%、9/59)和抗菌药物(5.1%、3/59)。而使用药物后DILI发生率前3位是中草药(11.7%、9/77)、抗结核药(2.9%、43/1501)和抗菌药物(0.8%、3/356)。结论初治住院结核病患者发生肝功能异常较常见,由多种因素所致,尽管由抗结核药物诱发的肝功能异常占主要构成比,但由其他药物诱发的肝功能异常同样需要关注。

Objective To investigate the causes of liver dysfunction of initially treated inpatients with tuberculosis.Methods The demographic characteristics and liver function indicators of initially treated patients with tuberculosis in Department of Infectious Diseases of the 920 Hospital of the People’s Liberation Army and People’s Hospital of Yuxi City of Yunnan Province from Junuary,2016 to December,2018 were collected and analyzed by retrospective cohort study.Results Total of 1501 patients from the above two hospitals were included,among whom,44.4%(669/1501)cases were accompanied by abnormal liver function during hospitalization,and 3.9%(59/1501)cases reached the standard of drug induced liver injury(DILI).The causes of liver dysfunction were induced by anti-tuberculosis drugs(48.3%,323/669),other drugs(36.9%,247/669),basic liver diseases(3.1%,21/669)and unknown causes(11.7%,78/669).The top three non-anti-tuberculosis drugs which caused liver dysfunction were antibiotics(15.7%,105/669),antipyretic painkillers(7.5%,50/669)and herbal medicines(7.5%,50/669).The top three drugs which caused DILI were anti-tuberculosis drugs(72.8%,43/59),herbal medicines(15.3%,9/59)and antibiotics(5.1%,3/59),while after using herbal medicine,anti-tuberculosis drugs and antibiotics,the rate of DILI was 11.7%(9/77),2.9%(43/1501)and 0.8%(3/356),respectively.Conclusions The causes of liver dysfunction in initially treated tuberculosis inpatients were common and multifactorial.Although the liver dysfunction induced by anti-tuberculosis drugs accounts for the main proportion,the liver dysfunction induced by other medications should be paid more attention.