抗结核药物肝毒性研究现状及其存在的问题

Status of studying antituberculosis drug-induced hepatotoxicity and its existing problems

肝损害是抗结核药物治疗中最常见的毒副作用之一。其发生机制尚不完全清楚,大多数抗结核药物的肝毒性是剂量依赖性的,部分与药物的超敏反应有关。老年、女性、营养不良、嗜酒、慢乙酰化表型、携带乙肝病毒或既往有肝病以及严重结核病是公认的危险因素。抗结核药物致肝损害的治疗目前尚无统一规范,以非特异性保肝、对症治疗为主,但加强监控与管理可预防严重肝损伤的发生。

Hepatotoxicity is one of the most common adverse reactions during anti- tuberculosis treatment. Mechanisms of antituberculosis drug-induced hepatotoxicity have not been clear yet,but most of the hepatotoxic reactions are dose-related,some are,however,caused by drug hypersensitivity. It is accepted that clinical risk factors for the development of hepatotoxicity during antituberculosis treatment are old age,female,malnutrition,alcoholism, slow acetylation phenotype, HBV carriers or patients with chronic liver diseases, and seribus tuber- culosis. Treatment of antituberculosis drug-induced hepatotoxicity has not been unified, and most of treatments are non-specific and symp- tomatic, but intensive clinical monitoring and regular follow-up is essential and helpful for preventing occurrence of serious liver injury.