400例初治结核患者抗结核药物致肝损伤分布特征及相关影响因素

Clinical Characteristics and related influencing factors of liver injury induced by antituberculosis drugs in 400 newly diagnosed tuberculosis patients

目的:探讨400例初治结核患者抗结核药物所致肝损伤(ATDILI)的分布特征及相关影响因素。方法:收集西安市胸科医院2017年6月至2020年1月间收治的3 120例初治结核患者临床资料,其中400例患者发生ATDILI,分析400例初治结核患者ATDILI分型及损伤程度情况,并采用多因素Logistic回归分析影响初治结核患者ATDILI的独立危险因素。结果:400例初治结核ATDILI患者中,肝损伤类型以肝细胞损伤为主,共236例,占59.00%;淤胆型肝损伤102例,占25.50%;混合型肝损伤62例,占15.50%。ATDILI损伤程度分级以轻度为主,共308例,占77.00%;中度66例,占16.50%;中重度及以上26例,占6.50%。单因素分析显示,年龄、Alb、HBV携带、合并系统性红斑狼疮、嗜酒与初治结核患者ATDILI有关(P<0.05);多因素Logistic回归分析显示,年龄≥60岁(P=0.011)、Alb<25 g/L(P=0.025)、既往肝病史(P=0.003)、合并系统性红斑狼疮(P=0.004)、嗜酒(P=0.017)为影响初治结核患者ATDILI的独立危险因素。结论:初治结核患者ATDILI损伤类型以肝细胞损伤为主,肝损伤程度以轻度肝损伤为主。年龄≥60岁、Alb<25 g/L、既往肝病史、合并系统性红斑狼疮、嗜酒可增加初治结核患者ATDILI发生风险。

Objective:To investigate the distribution and related influencing factors of anti-tuberculosis drug induced liver injury(ATDILI) in 400 new tuberculosis(TB) patients.Methods:The clinical data of 3 120 newly treated tuberculosis patients in our hospital from June 2017 to January 2020 were selected, including 400 cases with ATDILI and 2 720 cases without ATDILI. The ATDILI classification and injury degree of 400 TB patients were analyzed, and the single factor influencing atdili in TB patients was analyzed, and the independent risk of ATDILI in TB patients was analyzed by multivariate logistic regression analysis risk factors. Results:In 400 TB patients with ATDILI, 236 cases(59.00%) were liver cell injury, 102 cases(25.50%) were cholestatic type liver injury, and 62 cases(15.50%) were mixed type liver injury. According to ATDILI classification, 308 cases(77.00%) were mild injury, 66 cases(16.50%) were moderate injury, and 26 cases(6.50%) were moderate and severe injury.Univariate analysis showed that Age, Alb, HBV carrier, systemic lupus erythematosus and alcoholism were related to atdili in newly diagnosed tuberculosis patients(P<0.05);multivariate logistic regression analysis showed that Age≥60 years(P=0.011), ALB<25 g/L(P=0.025), liver history(P=0.003), systemic lupus erythematosus(P=0.004) and alcoholism(P=0.017) were independent risk factors for atdili in newly diagnosed tuberculosis patients. Conclusion:The main type of ATDILI injury was hepatocyte injury, and the degree of liver injury was mild liver injury. Age≥60 year, ALB<25 g/L, previous liver history, systemic lupus erythematosus(SLE) and alcoholism may increase the risk of ATDILI.