肺结核化疗期间肝损害及其对策

Liver injury through antituberculosis therapy and counter measures

目的:研究抗结核药物引起的肝损害对肺结核治疗的影响及相应对策。方法:对18例抗结核期间天门冬氨酸转氨酶(AST)值为正常值上限(ULN)2～6倍的患者,均给予保肝治疗,其中13例AST为2×ULN～4×ULN患者,维持原方案治疗,5例AST为4×ULN～6×ULN患者,将利福平改为利福喷丁治疗。结果:17例患者完成化疗,仅1例AST为5×ULN的老年男性复治患者因出现恶心、食欲不振和黄疸中止化疗。结论:如AST<6×ULN而无其他毒副反应,抗结核治疗可继续进行,加用保肝治疗,AST可恢复正常。

Objective: To study the measures for the management of liver injury through antituberculosis treatment. Methods: An increase in aspartate aminotransferase (AST), ranging from 2-6 times the upper limit of the normal (ULN) was recorded in 18 patients. The former therapy was continued fully in 13 patients (AST 2×ULN^4 × ULN), and a modified therapy (rifapentine instead of rifampicin) was reintroduced in the other 5 patients (AST 4×ULN^6XULN). At the same time, all 18 patients were treated with drugs for liver protection. Results: Treatment was finished successfully in 17 patients. Only one old male patient who had a relapse didn' t finish the treatment because of nausea, bad appetite and jaundice. Conclusions: In spite of an increase in AST level to approximately 6×ULN during antituberculosis therapy, the therapy can be continued in full in most cases and the drugs for liver protection are necessary at the same time.