142例抗结核药物性肝损伤患者临床特征分析

Clinical feature of 142 patients with anti-tuberculosis agents-induced DILI

目的回顾抗结核药导致的药物性肝损伤(DILI)患者临床资料,旨在分析其临床特征、生化指标与临床结局。方法2012年1月~2020年3月我院诊治的接受抗结核治疗期间被诊断为DILI患者142例,进行临床分型和肝损伤分度。结果在本组DILI患者中,诊断肝细胞型109例,胆汁淤积型17例,混合型16例;肝细胞型、胆汁淤积型和混合型患者血清ALT水平分别为(652.5±350.6)U/L、(172.6±92.8)U/L和(380.6±218.5)U/L,差异具有统计学意义(P<0.05),血清AST水平分别为(451.8±418.1)U/L、(185.5±105.2)U/L和(276.0±144.5)U/L,差异具有统计学意义(P<0.05),血清ALP水平分别为(94.5±77.5)U/L、(468.8±312.8)U/L和(209.1±144.5)U/L,差异具有统计学意义(P<0.05),血清总胆红素分别为(42.3±32.3)μmol/L、(126.8±103.5)μmol/L和(57.8±42.8)μmol/L,差异具有统计学意义(P<0.05),血清白蛋白分别为(36.8±7.2)g/L、(32.2±6.8)g/L和(33.0±7.0)g/L,差异具有统计学意义(P<0.05);以肝损伤程度分组,本组轻度102例,中度14例,重度26例。轻度肝损伤患者以小于60岁、无基础肝病和以肝细胞型为主,与其他两组比,差异显著(P<0.05);本组临床治愈95例,未愈47例。治愈患者年龄偏轻、血清AST、ALP和总胆红素水平偏低、而血清白蛋白水平偏高,与未愈患者比,差异显著(P<0.05)。结论因抗结核药物导致的DILI患者以肝细胞损伤型居多,年龄大、存在低蛋白血症和高胆红素血症患者预后差,应予以特别的关注。

Objective The aim of this study was to summarize the clinical feature of patients with anti-tuberculosis drug-induced liver injury(DILI).Methods 142 patients with anti-tuberculosis DILI were enrolled in this study between January 2012 and March 2020,and the clinical catalogue and liver injury severity were clarified.Results There were hepatocyte injury in 109,cholestasis in 17 and mixed injury in 16 in our series;serum ALT levels in patients with hepatocyte injury,cholestasis and mixed injury were(652.5±350.6)U/L,(172.6±92.8)U/L and(380.6±218.5)U/L,significantly different among them(P<0.05),serum AST levels were(451.8±418.1)U/L,(185.5±105.2)U/L and(276.0±144.5)U/L,significantly different among them(P<0.05),serum ALP levels were(94.5±77.5)U/L,(468.8±312.8)U/L and (209.1±144.5)U/L(P<0.05),total serum bilirubin levels were(42.3±32.3)μmol/L,(126.8±103.5)μmol/L and(57.8±42.8)μmol/L(P<0.05)and serum albumin levels were(36.8±7.2)g/L,(32.2±6.8)g/L and(33.0±7.0)g/L,all significantly different among them(P<0.05);there were mild liver injury in 102,moderate liver injury in 14 and severe liver injury in 26 patients out of the 142 patients,and the clinical feature of patients with mild liver injury included more younger than 60 year old,no underlying liver disease and presented with hepatocy injury;95 patients recovered and 47 not,and the recovered patients had more younger patients,low serum AST,ALP and bilirubin levels with relatively higher serum albumin levels,significantly different compared to those unrecovered(P<0.05).Conclusion The majority of patients with anti-tuberculosis DILI presents with hepatocyte injury,and those with low serum albumin and high total serum bilirubin levels are prone to have a poor prognosis.