肺结核病患者抗结核药物肝损害92例临床分析

Clinical analysis of 92 tuberculosis patients with hepatic lesion due to use of anti-tuberculosis drugs

目的分析抗结核药物性肝损害的危险因素及临床特点。方法2010年1月--2012年12月期间汕头市第三人民医院收集958例确诊的痰涂片阳性肺结核患者，包括初治患者726例，复治患者232例，对其中的92例抗肺结核药物治疗所致肝损害的临床资料进行分析。结果92例药物性肝损害患者中，女性抗结核药物性肝损害的发生率为13．10％（54／412）高于男性为6．95％（38，546），差异具有统计学意义（χ2=10．22，P=O．001）；92例中61例（66．30％）为肝炎型肝损害；15例（16．30％）为肝内胆汁淤滞型肝损害；16例（17．40％）为混合型肝损害；其中2例（2．16％）亦判定为过敏性药物性肝损害。异烟肼和利福平所致肝损害多出现于用药8周内；吡嗪酰胺所致肝损害多出现于用药8～12周内。乙胺丁醇一般与其他一线抗结核药物联合用药，所致肝损害多出现于用药12周后。结论女性中抗结核药物性肝损害的发生率高，认识抗结核药物性肝损害的常见临床类型和致病因素，可减少和避免抗结核药物性肝损害的发生。

Objective To analyze the risk factors associated with hepatic lesions due to use of anti-TB drug and clinical features of liver injury. Methods The clinical features and risk factors associated with hepatic lesions 92 liver lnjury patients due to use of antituberculosis drugs out oof the 726 initially treated and repeatedly treated tuberculosis cases in Shantou Municipal Third People＇s Hospital from January 2010 to December 2012 were consecutively enrolled. Results The hepatic lesion incidence in female liver injury, eases was 13.10% （54/412） was significantly higher than that of 6.95% of male patients （38/546）（χ2=10.22, P=0.001）Among the 92 hepatic lesion cases 61 cases （66.30%） were hepatitis cases, 15 cases （16.30%） were intrahepatic cholestasis type,16 case （17.40%） mixed type of hepatic lesions, 2 cases （2.16%） were due to allergic hepatic lesions. Isoniazid and rifampicin-indueed hepaptic lesions occurred eight weeks after medication, pyrazinamide-indueed hepatic lesions oeeurrred 8～12 weeks after treatment, while the hepatic lesions due to use of ethambutol incombination with other first-line anti-TB drugs might appear 12 weeks after treatment. Conclusion Anti-tuberculosis-induced hepatic lesions might easily occur to female tubereulesis patients. Early recognize hepatic lesions due to use of anti-tuberculosis drugs and the clinical features can reduce or is helpful to understanding the common clinical types and causes of liver injury may reduce and/or avoid the occurrence of hepatic lesions due to use of anit-tuberculesis drugs.