无锡地区一线口服抗结核药物所致药物性肝损伤多因素分析

Multivariate analysis of drug-induced liver injury caused by first-line anti-tuberculosis drug in Wuxi area

目的分析无锡地区结核病专科医院住院患者由于一线抗结核药物所致药物性肝损伤的主要因素。方法选择2013年1月至12月在无锡市第五人民医院抗结核治疗患者共830名,分成药物性肝损组(102例)和非药物性肝损组(728例),并对其采用单因素和多因素条件logistic回归分析。结果通过单因素分析发现,有5项因素差异有统计学意义,包括HIV感染,乙肝病毒携带,嗜酒,含吡嗪酰胺的抗结核方案及营养不良。多因素条件logistic回归分析显示,乙肝病毒携带,含吡嗪酰胺的抗结核方案及营养不良为抗结核药致药物性肝损伤的危险因素。结论乙肝病毒携带,含吡嗪酰胺的抗结核方案及营养不良是服用一线抗结核药物发生药物性肝损伤的主要因素,在临床工作中应当重视上述相关的危险因素,并给予必要的干预。

Objective To analyze the principal factor of drug-induced liver injury caused by first-line antituberculosis drug in Wuxi special tubercular hospital. Methods 830 patients fro January to December 2013 in Wuxi NO. 5 people＇s hospital were divided into the drug-induced liver injury group（ 102 patients） and the non-drug-induced liver injury group（ 728 patients）. Univariate and multiple conditional logistic regression was used to analyze the risk factors. Results 5 significantly different factors were identified through univariate analysis,including HIV infection,hepatitis B virus carrier,intemperance,therapeutic schedule of tuberculosis including Pyrazinamide and malnutrition. And multiple conditional Logistic regressions analysis showed that hepatitis B virus carrier,therapeutic schedule of tuberculosis including Pyrazinamide and malnutrition were risk factors of antituberculosis drug-induced liver injury. Conclusion The main risk factors are hepatitis B virus carrier,therapeutic schedule of tuberculosis including Pyrazinamide and malnutrition for induced liver injury caused by first-line anti-tuberculosis drug. More attentions should be paid to these factors in daily work and necessary interventions should be given.