抗结核药所致药物性肝病分析

Analysis of drug-induced Liver Disease

目的:总结抗结核药所致药物性肝病(D ILD)的临床特点、探讨其预防和治疗。方法:根据服药史、临床表现、肝功能检查、影像学检查及药物性肝病诊断标准,对1998年1月至2005年1月间经抗结核治疗后出现的68例患者进行临床分析和讨论。结果:接受抗结核治疗306例患者中,乙型肝炎病毒标志物HBsAg阳性者29例,其中12例出现肝损害,占41.4%,HBsAg阳性者药物性肝损害高于阴性(P<0.01);306例患者中,68例肝功能异常,占22.2%,其中19例经护肝治疗后,肝功能恢复正常,继续原方案化疗,同时予护肝治疗,未再次出现肝损害,不必停抗结核药。有42例(占61.8%)病人更改方案,停抗结核药5例(占7.4%)。结论:多种抗结核药可引起药物性肝病;联合用药可增加药物的毒性;HBsAg阳性者抗结核治疗中易出现肝损害;在抗结核治疗前应常规检查肝功能、HB-sAg,在用药过程中应定期监测肝功能;应早期发现药物性肝病,早期停用可疑药物及进行相应治疗。

Objective： Summarizes the clinical characteristic of the drug - induced liver disease （DILD） suffered from anti - tuberculosis drugs, and discusses its prevention and the treatment. Methods： According to take the medicine ＇usage history , the clinical manifestation, the liver function examination, the video examination and the diagnoses standard of DILD , 68 inpatients suffered from hepatitis resulted from antituberculosis drugs during January, 1998 from January, 2005 were clinical analyzed and discussed. Results： In accepts the anti - tuberculosis to treat in 306 examples patients,the hepatitis B virus HBsAg masculine were 29 examples, 12 examples appeared the liver harm, accounts for 41.4%, the masculine medicine liver harm was higher than the negative （ P 〈 0.01 ）. In 306 sufferers,68 examples liver function were abnormality, account for 22.2%, among those examples, 19 examples （ 27.9% ） after protected the liver treatment, the liver function restores normally,continues the original plan chemotherapy and at the same time gives protects the liver treatment, the liver harm did not appear once more, did not need to stop the medicine ,42 examples （61.8%） changes the treatment plan, 5 examples （7.4%） stopped the anti - tuberculosis medicine . Conclusion： Many kinds of anti - tuberculosis medicine can cause the medicine disease of the liver, consociation uses anti - tuberculous medicines may increase the toxicity of the medicine. In the HBsAg masculine patients, anti - tuberculosis treatment is easy to appear the liver harm,before the anti - tuberculous treatment should inspect liver function, HBsAg. In the process of treatment should inspect liver function ; Should early discovery medicine disease of the liver, and early time stops using the suspicious medicine and carries on the corresponding treatment.