肺结核患者化疗后肝损伤程度与临床表现的相关性分析

Correlation between liver damage degree and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy

目的探讨肺结核患者化疗后肝损伤程度与临床表现的相关关系。方法选取2008年1月-2014年1月在本院接受一线抗结核药物治疗的新发涂阳肺结核患者3620例,为其建立用以记录服药情况及抗结核药物不良反应的随访日历。计数资料采用χ^2检验。结果 1225例（33.8%）患者出现肝损伤相关临床表现。临床表现以恶心呕吐发生率最高（72.9%）,其余依次为小便颜色改变（65.3%）、疲乏（37.8%）、出疹（31.5%）、腹胀腹泻（28.1%）、发热（14.2%）、纳差（3.8%）、其他（2.0%）。在不同临床表现中恶心呕吐出现时间最早,其次为腹胀腹泻。所有患者中出现肝损伤243例（6.7%）,中重度肝损伤109例（3.0%）。有临床表现者中出现肝损伤171例（14.0%）,中重度肝损伤74例（6.0%）。有临床表现者发生肝损伤、中重度肝损伤与无临床表现者危险度之比分别为4.643（95%CI：3.035~4.856）、4.134（95%CI：2.817~4.351）。出现疲乏、恶心呕吐、出疹、腹胀腹泻、纳差、其他表现者其肝损伤及中重度肝损伤发生危险性高于无临床表现者（P〈0.05）,其中出现纳差者危险性最高,其危险度之比分别为12.792、25.031。结论 1/3肺结核患者化疗后出现肝损伤相关临床表现,当出现疲乏、恶心呕吐、出疹、腹胀腹泻、纳差、其他表现者其肝损伤及中重度肝损伤发生危险性升高。

Objective To explore the correlation between the degree of liver damage and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy. Methods This study included 3620 new smear- positive pulmonary tuberculosis patients treated with first- line anti- tuberculosis drug in the Second Central Hospital of Baoding from January 2008 to January 2014,and the follow- up study was carried out to observe medication use and side effects of anti- tuberculosis drug treatment. Comparison of categorical data was made by chisquare test. Results A total of 1225 patients（ 33. 8%） exhibited clinical manifestations related to liver injury. The most common clinical manifestation was nausea and vomiting（ 72. 9%）,followed by fatigue（ 37. 8%）,rash（ 31. 5%）,abdominal distension and diarrhea（ 28. 1%）,fever（ 14. 2%）,anorexia（ 3. 8%）,and other manifestations（ 2. 0%）. The nausea and vomiting usually first appeared and were followed by abdominal distension and diarrhea. Of all patients,243 cases（ 6. 7%） suffered from liver damage and 109 cases（ 3. 0%）had moderate to severe liver damage. Of the patients with clinical manifestations,171 cases（ 14. 0%） had liver damage and 74 cases（ 6. 0%） suffered from moderate to severe liver damage. Compared with the patients without clinical manifestations,the relative risks of liver damage and moderate to severe liver damage were 4. 643 [95% confidence interval（ CI） = 3. 035- 4. 856]and 4. 134（ 95% CI = 2. 817-4. 351）,respectively,in the patients with clinical manifestations. The patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations had higher risk of liver damage and moderate to severe liver damage than those without clinical manifestations（ P〈 0. 05） and the patients with anorexia showed the highest risk. Conclusion One third of patients with pulmonary tuberculosis have liver injury- related clinical manifestations after chemotherapy. Patients with fatigue,nausea and vomiting,rash,abdominal distension and diarrhea,anorexia,and other manifestations are more susceptible to liver damage and moderate to severe liver damage.