摘要
目的 探讨肝脏基础疾病对抗结核药物性肝损伤的影响及评价若干肝损伤防治措施的临床效果.方法 对2011年1月至2012年12月收治的全部1337例患者（A组）实施肝损伤防治措施（其中有肝脏基础疾病患者287例）,肝损伤患者245例为B组;B组又分为肝损伤前未接受防治措施211例为B1组和接受防治措施后发生肝损伤34例为B2组.分析肝脏基础疾病对抗结核药物性肝损伤的影响并评价防治效果.计数资料采用x2检验,计量资料采用t检验,P＜0.05为差异有统计学意义.结果 有肝脏基础疾病患者肝损伤发生率40.4％（116/287）,高于无基础疾病患者（12.3％,129/1050）;合并乙型肝炎患者肝损伤发生率58.5％（83/142）,高于全部患者（18.3％,245/1337）,差异均有统计学意义（x2值分别为16.2320、119.7547,P值均＜0.01）.B1组丙氨酸转氨酶（ALT）≥8倍正常值上限（ULN） （41/211）或（和）总胆红素（TBIL）≥4倍ULN者（44/211）高于B2组（0/34和2/34）,差异均有统计学意义（x2值分别为7.9344、4.3033,P＜0.01或P＜0.05）.B2组ALT、天门冬氨酸转氨酶（AST）、谷氨酰转肽酶（GGT）、TBIL、直接胆红素（DBIL）和间接胆红素（IBIL）[（173.8±197.0） IU/L、（113.3±208.6） IU/L、（74.5±73.4） IU/L、（22.3±84.9） μmol/L、（11.3±36.9）μmol/L、（10.7±25.4） μmol/L]均低于B1组[（343.4±235.4） IU/L、（270.7±246.6） IU/L、（115.5±83.5） IU/L、（84.6±102.6） μmol/L、（34.7±42.8）μmol/L、（30.5±30.7）μmol/L],而白蛋白（Alb）[（35.5±3.8） g/L]高于B1组[（32.5±3.7） g/L],差异均有统计学意义（t值分别为3.9805、3.5226、2.6990、3.2093、2.8648、3.4089和t’=4.0968,P值＜0.01或＜0.05）.B2组治疗中断率低于B1组（2/34,211/211）,差异有统计学意义（x2=220.2098,P＜0.01）.结论 肝脏基础疾病可增加抗结核药物性肝损伤发生,抗结核治疗中执行肝损伤防治措施可减少肝损伤的发生并减少治疗中断率.
Objective Study on the relationship between some foundation diseases in liver and antituberculosis drug-induced liver injury to approach the controlling and preventing measures. Methods For patients with other liver disease before anti-TB treatment, records the patient＇s medical history and laboratory test results, develop- ment of appropriate anti-TB treatment regime to take measures to protect the liver. Assess effect of these measures in the treatment process of 1337 cases from January 2011 to December 2012. The data uses the card side examina- tiom the measurement uses the t-test, carries on statistics analysis. P^0. 05 means significance differences. Results Incidence of liver injury in patients with underlying disease of the liver （40.4%, 116/287）, was higher than patients without underlying disease （12.3% ,129/1050） Merged incidence of liver injury in patients with hepatitis b （58.5%,83/142）, above all of the cases （18. 3%, 245/1337）, the differences were statistically significant （t^3. 9805,3. 5226,2. 6990,3. 2093,3. 8648,3. 4089 and t＇=4. 0968, P-value 〈0. 01 or 〈0.05）. Treat- ment of group B2 group interrupt rate is lower than B1 （2/34,211/211） and the difference was statistically significant （X2 =220. 2098, P〈0.01）. Conclusion The study suggests the some liver diseases can significantly increase the liver injury induced by anti-tuberculosis drugs, implementation of anti-TB treatment liver damage control measures can reduce the incidence of liver damage and reduce the rates of treatment interruption.
出处
《中国防痨杂志》
CAS
2014年第1期9-13,共5页
Chinese Journal of Antituberculosis
关键词
抗结核药
肝炎
中毒性
肝疾病
Antitubercular agents
Hepatitis, toxic
Liver diseases
