摘要
目的为探讨利福平与异烟肼合用致肝损害的临床表现与病理变化的关系。方法对１９４例应用利福平与异烟肼治疗的初治结核患者进行了临床与病理分析，其中２８例行经皮肝穿刺活组织检查（活检），另１７例行两次肝活检。结果５９例乙型肝炎病毒标志物（ＨＢＶＭ）阳性者，治疗后出现肝功能异常２１例（３５．６％），１３５例ＨＢＶＭ阴性者中１３例（９．７％）肝功能异常，两组比较Ｐ＜０．０１。且血清丙氨酸转氨酶（ＡＬＴ）的变化与肝脏病理损害程度大致成正比。当停用利福平和异烟肼或减量后，其ＡＬＴ与肝脏病理损害大多在６周以内恢复正常。利福平（Ｒ）与异烟肼（Ｈ）致肝病理损害与慢性乙型肝炎比较本质上无明显差别，但表现形式上有两点不同：汇管区炎症细胞不同，前者以嗜酸性粒细胞为主，后者以淋巴细胞为主；前者肝内胆汁淤积发生率较高。结论抗结核治疗时ＨＢＶＭ阳性者比阴性者更易发生肝损害，与其用药前即存在肝病理损害有关；ＲＨ与乙型肝炎病毒致肝损害的机理可能不同。
Objective To explore the relationship between clinical manifestations and pathological changes of liver injury resulting from rifampin and isoniazid. Method 194 cases treated with rifampin and isoniazid, among them liver biopsies were done once in 28 cases, twice in 17 cases, were observed. Results 21 of 59 cases with positive HBVM and 13 out of 135 cases with negative HBVM showed abnormal liver function after treatment, and the elevation of ALT was in accordance with the degree of liver pathological injury. Elevated ALT and liver pathological injury returned to normal within 6 weeks after rifampin and isoniazid were stopped or reduced in doses. No significant difference was found between chronic hepatis B and rifampin, isoniazid in causing liver pathological injury, but two different points were noted in their manifestations: 1. The cells mainly caused portal inflammation were lymphocytes in the former, while eosinophils in the latter. 2. The incidence of intrahepatic cholestasis was higher in the latter. Conclusion The incidence of liver injury in HBVM positive group is higher than that in HBVM negative group because liver injury exists in the former before treatment, and the mechanisms causing liver injury may be different.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
1997年第1期33-35,共3页
Chinese Journal of Tuberculosis and Respiratory Diseases
