抗结核药致肝损害1949例文献分析

Literature analysis of 1949 cases liver injury induced by anti-TB drugs

目的：探讨抗结核药致肝损害的临床特点和危险因素，为临床合理用药提供参考。方法以抗结核药、肝损害、肝损伤等词为检索词，检索中国知网CHKD期刊全文数据库和万方医学数据库，收集抗结核药致肝损害的文献进行统计分析。结果共收集到抗结核药致肝损害患者1949例，其中男性1209例（62．03％），女性740例（37．97％）；年龄14～89岁。原发疾病均为结核病，伴有乙肝病毒或丙肝病毒感染者305例（15．65％），伴有酗酒者202例（10．36％）。发病时间为用药后7～60 d。临床表现以消化系统症状、乏力、皮疹、发热为主。实验室检查以肝功能指标异常为主。停药并给予保肝及对症治疗后，1770例（90．82％）治愈；170例（8．72％）好转；9例（0．46％）死亡。结论抗结核药所致肝损害发生率为10．58％，发生率较高，但除重度肝损害外大多愈后良好。抗结核治疗时，少年及老年人是高危人群，肝炎病毒感染及酗酒是危险因素，必须加强肝功能检测，早发现、早治疗，以便有利于肝功能恢复正常。

Objective This paper is to discuss the clinical features and hazards about hepatic lesion caused by anti‐TB drugs ,as to provide a reference for clinical rational drug use .Methods By using anti‐TB drugs hepatic lesion ,hepatic injury as index words , CHKD journal full‐text database and Wanfang medical database were researched to collect documentary concerning hepatic lesion caused by anti‐TB drugs .Results 1 949 cases were collected about patients with liver damage caused by anti‐TB drugs ,1 209 （62 .03% ） male patients with liver damage ,740（37 .97% ） female patients with liver damage ,age from 14‐89 .Primary disease were all tuberculosis ,in which 305 （15 .65% ） patients associated with hepatitis B and C virus infection ,202 （10 .36% ）patients a‐bout alcoholics ,7‐60 days after the drug use .Clinical manifestations showed the digestive system symptoms ,fatigue ,skin rash or fever .1 770（90 .82% ） patients were cured through protecting liver treatment and expectant treatment after stopping drugs ,170 （8 .72% ） patients improved ,while 9（0 .46% ）died .Conclusion The incidence of liver damage caused by anti‐TB drugs was 10 . 58% .The young and the old were at higher risk .Hepatitis B and C virus infection and alcohol abuse are dangerous factors during the anti‐TB treatment .Liver function test ,earl detection ,and early treatment are necessary .