抗结核药物致肝损害的临床研究
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摘要
目的探讨肺结核病人服用抗结核药物所致肝损害的状况,为抗结核治疗提供个性化依据。方法将2015年1月～2016年12月由邯郸市辖区16个县(市、区)结核病定点医疗机构、市传染病医院上送的所有初治痰结核分枝杆菌培养阳性病例作为研究对象。结果 (1)肺结核组肝损害发生率13. 0%(65/500),高于对照组的7. 8%(39/500),差异有统计学意义(χ2=7. 25,P <0. 05)。(2)不同性别肺结核病人肝损害发生率男性12. 5%(48/36),高于女性的10. 4%(17/164),差异无统计学意义(χ2=1. 50,P> 0. 05)。(3)不同年龄肺结核病人肝损害15～30岁组10. 1%(18/178),低于60岁以上组的17. 3%(26/150),差异有统计学意义(χ2=4. 24,P <0. 05)。结论抗结核药致肝损害比其他药物发生率高,尤其是老年病人。故抗结核治疗时要密切检测、预防药物性肝损害,做到早发现、早诊断、合理治疗,保证治疗的依从性,提高治愈率。
Objective To investigate the status of liver damage caused by taking anti-tuberculosis drugs among patients with pulmonary tuberculosis and to provide personalized basis for anti-tuberculosis treatment. Methods From January 2015 to December 2016,all newly diagnosed sputum Mycobacterium tuberculosis positive cases from TB medical institutions and municipal infectious disease hospitals in 16 districts( municipalities and districts) in municipal districts were studied. Results(1)The incidence of liver damage in the tuberculosis group was 13. 0%( 65/500),which was significantly higher than 7. 8%( 39/500) in the control group( χ2= 7. 25,P < 0. 05). The difference was statistically significant.(2)The incidence of liver damage of male tuberculosis patients was 12. 5%( 48/36),higher than that of female patients( 10. 4%)( 17/164)( χ2= 1. 50,P >0. 05). The difference was not statistically significant.(3)The liver damage in patients with the age group of 15 ～ 30 years old was 10. 1%( 18/178),less than 17. 3%( 26/150) of the age group of over 60 years old. The difference was statistically significant( χ2= 4. 24,P < 0. 05). Conclusion The incidence rate of liver damage caused by anti-tuberculosis drugs is higher than other drugs,especially in elderly patients. Therefore,anti-TB treatment should be closely tested to prevent drug-induced liver damage. Early detection,early diagnosis and reasonable treatment should be conducted to ensure the compliance with treatment and improve the cure rate.
Objective To investigate the status of liver damage caused by taking anti-tuberculosis drugs among patients with pulmonary tuberculosis and to provide personalized basis for anti-tuberculosis treatment. Methods From January 2015 to December 2016,all newly diagnosed sputum Mycobacterium tuberculosis positive cases from TB medical institutions and municipal infectious disease hospitals in 16 districts( municipalities and districts) in municipal districts were studied. Results(1)The incidence of liver damage in the tuberculosis group was 13. 0%( 65/500),which was significantly higher than 7. 8%( 39/500) in the control group( χ2= 7. 25,P < 0. 05). The difference was statistically significant.(2)The incidence of liver damage of male tuberculosis patients was 12. 5%( 48/36),higher than that of female patients( 10. 4%)( 17/164)( χ2= 1. 50,P >0. 05). The difference was not statistically significant.(3)The liver damage in patients with the age group of 15 ～ 30 years old was 10. 1%( 18/178),less than 17. 3%( 26/150) of the age group of over 60 years old. The difference was statistically significant( χ2= 4. 24,P < 0. 05). Conclusion The incidence rate of liver damage caused by anti-tuberculosis drugs is higher than other drugs,especially in elderly patients. Therefore,anti-TB treatment should be closely tested to prevent drug-induced liver damage. Early detection,early diagnosis and reasonable treatment should be conducted to ensure the compliance with treatment and improve the cure rate.
引文
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[8]马凌摇,杨芳玲,杨奇帅.抗结核药物致肝损害80例临床分析[J].临床肺科杂志,2012,17(11):2092-2093.
[9]张井凡,卢春凤.抗结核药物引起肝脏损伤研究进展[J].黑龙江医药科学,2014,37(4):83-84.
[10]崔国强.抗结核药物致肝功能损害临床分析[J].临床肺科杂志,2014,19(6):1061-1063.
[2]中华医学会结核病学分会.抗结核药所致药物性肝损伤诊断处理专家建议[J].中华结核和呼吸杂志,2013,36(10):732-736.
[3]李峰,卢永华.抗结核药物所致药物性肝损害[J].中华临床医师杂志(电子版),2004,8(23):4173-4176.
[4] RANGNEKAR AS,FONTANA RJ. An update on drug induced liver injury[J]. Minerva Gastroenterol Dietol,2011,57(2):213-229.
[5]肖和平,顾瑾.抗结核药物性肝损伤的临床特点[J].中国防痨杂志,2013,35(7):485-487.
[6]侍羽,赵丽.抗结核药致肝损害85例[J].中国医院用药评价与分析,2016,16(12):1712-1714.
[7]安慧茹,王仲元,吴雪琼,等.老年肺结核患者抗结核药物性肝损害的预防探讨[J].四川医学,2012,33(11):1875-1876.
[8]马凌摇,杨芳玲,杨奇帅.抗结核药物致肝损害80例临床分析[J].临床肺科杂志,2012,17(11):2092-2093.
[9]张井凡,卢春凤.抗结核药物引起肝脏损伤研究进展[J].黑龙江医药科学,2014,37(4):83-84.
[10]崔国强.抗结核药物致肝功能损害临床分析[J].临床肺科杂志,2014,19(6):1061-1063.