文章摘要
陈诗娴,周玲,陈永忠,潘洪秋,唐少文.住院抗结核治疗患者药物性肝炎发生及转归研究[J].中华流行病学杂志,2016,37(7):930-934
住院抗结核治疗患者药物性肝炎发生及转归研究
Incidence and outcome of anti-tuberculosis drug-induced hepatotoxicity in tuberculosis inpatients
投稿时间:2016-02-28  
DOI:10.3760/cma.j.issn.0254-6450.2016.07.005
中文关键词: 抗结核药物;药物性肝炎;发生率;发生时间;住院治疗
英文关键词: Anti-tuberculosis drug;Drug-induced hepatitis;Incidence;Onset time;Hospitalization
基金项目:国家自然科学基金(81373066)
作者单位E-mail
陈诗娴 211166 南京医科大学流行病学系  
周玲 211166 南京医科大学流行病学系 lzhou@njmu.edu.cn 
陈永忠 212005 镇江市第三人民医院结核病科  
潘洪秋 212005 镇江市第三人民医院结核病科  
唐少文 211166 南京医科大学流行病学系  
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中文摘要:
      目的 基于江苏省镇江市第三人民医院2006-2012年结核病患者病案资料及出院后门诊随访记录,分析治疗过程中药物性肝炎的发生情况,为抗结核药致肝损害的预防与控制提供依据。方法 根据结核病患者的住院病历及肝功能检测记录,采用两种标准(国际共识会议标准和美国胸科协会标准)判断肝损害,并对其相关因素及转归进行分析。结果 2006-2012年住院抗结核治疗患者共1 967例,男性1 403例(71.3%),肺结核1 790例(91.0%),初治患者1 528例(77.8%),涂阳患者979例(49.8%),合并其他疾病1 297例(65.9%)。在两种标准下,抗结核药致肝损伤的发生率分别为16.5%和8.3%,肝损害发生的中位时间为25 d和23 d。使用HRZE四联治疗方案者肝损害发生率显著高于其他方案组,男性发生率高于女性(P<0.05)。肝损害发生后,两种标准下分别有69.5%和70.1%的患者改变原有方案;经过调整药物或停药后,89.8%和88.4%的患者肝酶恢复正常。结论 在两种标准下,住院抗结核治疗过程中分别有16.5%和8.3%的患者发生药物性肝炎,且多发生在治疗的前一个月内。因此,在抗结核治疗初期,对采用HRZE方案及男性结核病患者应加强监测,以减少药物性肝炎的发生。
英文摘要:
      Objective Based on the medical records and follow-up records of hospitalized patients who received anti-tuberculosis therapy in the Third People's Hospital of Zhenjiang in Jiangsu province from 2006 to 2012, we investigated the incidence and outcome of anti-tuberculosis drug induced hepatotoxicity (ATDH) and provided evidence for the prevention of ATDH. Methods According to tuberculosis patients'medical information and liver function test records, ATDH patients were diagnosed according to the criteria of International Consensus Meeting and American Thoracic Society respectively, then the related factors and outcomes were analyzed. Results A total of 1 967 hospitalized tuberculosis patients were reviewed retrospectively, in which 1 403 (71.3%) were men, 1 790 (91.0%) were pulmonary tuberculosis patients, 1 528 (77.8%) were patients receiving initiative treatment, 979 (49.8%) were sputum smear-positive patients, and 1 297 (65.9%) had other complicated diseases. According to the criterion of International Consensus Meeting, the incidence of ATDH was 16.5%, the median time of onset was 25 days. According to the criterion of American Thoracic Society, the incidence of ATDH was 8.3%, the median time of onset was 23 days. The incidence of ATDH was significantly higher in males and HRZE therapy group (P<0.05). Under the two liver criteria, 69.5% and 70.1% of the patients changed primary therapy respectively after ATDH occurred. 89.8% and 88.4% patients' liver function returned to normal range after changing or stopping therapy. Conclusion According to two liver injury criteria, the incidences of ATDH were 16.5% and 8.3% in hospitalized tuberculosis patients respectively, and ATDH mainly occurred in the first month of anti-tuberculosis treatment. The monitoring of liver function should be strengthened in males and HRZE therapy group to reduce the incidence of ATDH.
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