抗结核药物治疗致患者肝损伤死亡二例并文献复习

Liver injury caused by anti-tuberculosis： 2 cases report and review of the literature

目前,我国对抗结核药物引起的严重药物性肝损伤（drug-induced liver injury,DILI）死亡患者的报道较少,缺乏对临床诊疗及救治的参考依据.作者通过报道首都医科大学附属北京胸科医院于2012年和2013年收治的2例初治肺结核患者,在给予2H-R-Z-E/4H-R方案行抗结核药物治疗后,分别于服药2周及2个月时出现了严重的DILI,短时间内病情持续恶化,最终导致急性肝功能衰竭而死亡的诊治过程.作者并进行了文献复习,分析并探讨了一线抗结核药物引起DILI的发生机制、严重DIH的临床表现及诊治方法和预防,旨在引起临床医师对早期DILI临床表现的重视,并且能够在患者出现DILI时及时处理,避免急性肝衰竭的发生.

There are few reports on the death of drug induced liver injury （DILl） caused by anti-tuberculosis drug in China, in addition, evidences for clinical diagnosis and treatment are limited. The article reports two deaths of DILl caused by 2H-R-Z-E/4H-R anti-tuberculosis. Both pulmonary tuberculosis patients were from Beijing Chese Hospital affiliated to Capital Medical University and were all first-treated; one was diagnosed in 2012 and the DILl broke out 2 weeks after treatment, the other one was diagnosed in 2013 and the DILI broke out 2 months after treatment. The conditions continue to deteriorate within a short period, eventually causing acute liver failure and death. The authors reviewed the related literature, and explored the pathogenesis and manifestations of DILl caused by first-line anti-tuberculosis drugs, manifestation, treatment for DIM, as well as how to prevent from DILl; in order to call more attentions to early clinical manifestations of DILI. Therefore, clinicians could be able to provide timely treatments to avoid occurrences of acute liver failure.