抗结核药物致药物性肝炎210例临床分析

Antituberculosis Drug-induced Hepatitis: A Clinical Analysis of 210 Cases

目的探讨抗结核药物所致药物性肝炎的临床特点及预防策略。方法对210例抗结核药物所致药物性肝炎患者的临床资料进行回顾性分析。结果抗结核药物所致药物性肝炎患者临床表现无特异性,患病年龄以>20～40岁者为主,占49.1%;临床分型以肝细胞损伤型为主,占64.8%;轻、中度肝损害者占76.2%,重度肝损害者占23.8%;合并基础肝病者(48.0%)更易发生,其中合并乙肝病毒感染者发生率占35.7%。治愈179例(85.2%),好转25例(11.9%),死亡6例(2.9%)。结论评估肝脏基础状况并采取必要的预防措施、制定合适的抗结核方案和监测肝功能是预防药物性肝炎的重要策略,必须引起临床医生的高度重视。

Objective To investigate the clinical features and preventive strategies in antituberculosis drug-induced hepatitis.Methods Clinical data of 210 patients with antituberculosis drug-induced hepatitis were analyzed retrospectively.Results The clinical manifestation of antituberculosis drug-induced hepatitis was non-specific.Patients were mainly 20-40 years of age（49.1%） and hepatocellular damage was the mainly clinical classification（64.8%）.Mild to moderate liver damage occurred in 76.2% of the patients and severe liver damage in 23.8%.Moreover,hepatocellular damage associated with elementary hepatic disease occurred in 48.0% of the patients（hepatocellular damage associated with hepatitis B virus infection accounted for 35.7%）.Among the 210 patients,complete recovery occurred in 179（85.2%）,improvement in 25（11.9%） and death in 6（2.9%）.Conclusion The evaluation of elementary hepatic condition,selection of necessary precautions,development of appropriate antituberculosis program and monitoring of liver function may be the important preventive strategies for antituberculosis drug-induced hepatitis.Therefore,more attention must be paid by clinicians.