抗结核药物对肺结核伴慢性肝病患者致肝损伤的临床分析及其对抗结核治疗的影响

Clinical Analysis on Liver Injury Induced by Anti-TB Drugs in Chronic Liver Disease Patients with TB and Its Influence on Anti-TB Treatment

目的:分析抗结核药物对肺结核伴慢性肝病患者致药物性肝损伤的临床特征及其对抗结核治疗的影响。方法:选取2014年1月-2018年12月间收治的被确诊为初发初治肺结核患者926例资料,分析其患者按正规抗结核方案(2HREZ/4HR)治疗过程中致药物性肝损害与有无慢性肝炎、合并不同类型慢性肝炎、肝损害程度及其临床分型的相关性,以及对抗结核药物治疗的影响。结果:926例初发初治肺结核患者(其中236例患者伴有慢性肝炎,690例无肝脏基础疾病)治疗过程中,690例无肝脏基础疾病患者出现药物性肝损害213例(30.87%);236例伴有慢性肝炎患者治疗中出现肝损害104例(44.07%);有慢性肝病的肺结核患者肝损伤发生率显著高于无肝脏基础疾病患者(P<0.05);伴有慢性乙型肝炎的肺结核患者药物性肝损害发生率高、肝功能损害程度重;药物性肝损害较易出现在抗结核药物治疗强化期内。结论:有慢性肝病的患者在抗结核药物治疗中应密切监测其肝功能的变化,尤其是在抗结核强化期内,必要时调整抗结核药物治疗方案或停用抗结核药物治疗,以免造成不可逆的严重后果。

Objective: To analyze the clinical characteristics of drug-induced liver injury induced by anti-tuberculosis(anti-TB) drugs in pulmonary tuberculosis patients with chronic liver disease and its influence on anti-TB treatment.Methods: The data of 926 newly diagnosed patients with tuberculosis admitted from January 2014 to December 2018 were selected. The correlation between drug-induced liver damage and the presence or absence of chronic hepatitis,different types of chronic hepatitis,the degree of liver damage and its clinical type were analyzed,as well as the impact of anti-tuberculosis drug treatment in patients treated with the formal anti-tuberculosis program(2 HREZ/4 HR) was also analyzed. Results:926 patients with primary tuberculosis(236 patients with chronic hepatitis and 690 without underlying liver disease) showed drug-induced liver damage in 690 patients without underlying liver disease(30.87%).Liver damage occurred in 104 cases(44.07%) among 236 cases with chronic hepatitis. The incidence of liver injury in pulmonary tuberculosis patients with chronic liver disease was significantly higher than that in patients without underlying liver disease(P<0.05). The incidence of drug-induced liver damage was high and the degree of liver function damage was serious in pulmonary tuberculosis patients with chronic hepatitis B. Drug-induced liver damage was more likely to occur during the intensification period of anti-tuberculosis drug treatment. Conclusion: The changes in liver function in patients with chronic liver disease should be closely monitored during anti-TB drug therapy,especially during the anti-TB intensification period. Anti-TB drug treatment regimen should be adjusted or discontinuation of anti-TB medication,if necessary, so as not to cause irreversible serious consequences.