蒋旭华, 黄玉仙, 卢水华, 李涛, 卢洪洲. 抗结核药物引起肝损伤的临床特点及相关因素[J]. 上海预防医学, 2017, 29(7): 518-522,544. DOI: 10.19428/j.cnki.sjpm.2017.07.003
引用本文: 蒋旭华, 黄玉仙, 卢水华, 李涛, 卢洪洲. 抗结核药物引起肝损伤的临床特点及相关因素[J]. 上海预防医学, 2017, 29(7): 518-522,544. DOI: 10.19428/j.cnki.sjpm.2017.07.003
Xu-hua JIANG, Yu-xian HUANG, Shui-hua LU, Tao LI, Hong-zhou LU. Clinical characteristics and correlative factors of drug-induced liver injury caused by anti-tuberculosis drugs[J]. Shanghai Journal of Preventive Medicine, 2017, 29(7): 518-522,544. DOI: 10.19428/j.cnki.sjpm.2017.07.003
Citation: Xu-hua JIANG, Yu-xian HUANG, Shui-hua LU, Tao LI, Hong-zhou LU. Clinical characteristics and correlative factors of drug-induced liver injury caused by anti-tuberculosis drugs[J]. Shanghai Journal of Preventive Medicine, 2017, 29(7): 518-522,544. DOI: 10.19428/j.cnki.sjpm.2017.07.003

抗结核药物引起肝损伤的临床特点及相关因素

Clinical characteristics and correlative factors of drug-induced liver injury caused by anti-tuberculosis drugs

  • 摘要:
    目的了解抗结核药物引起药物性肝损伤的临床特征,探寻可能的诱因。
    方法回顾性收集2016年收治于上海市公共卫生临床中心接受抗结核药物治疗患者的资料。分析其人口学、治疗方案、生化指标等数据。组间比较运用t检验(正态分布)、Mann-Whitney法(非正态分布)和Fisher精确检验(非数值型),相关因素分析用logistic回归。
    结果筛选后共48例纳入本研究,其中药物性肝损伤组18例,对照组30例。平均年龄(36.65±21.62)岁,男女比例为2:1。5.56%(1/18)病例为肝细胞损伤型,22.22%(4/18)病例为混合型,72.22%(13/18)病例为胆汁淤积型。重度肝损伤(严重程度3级及以上)患者占50.00%(9/18)。以“异烟肼+乙胺丁醇”组合为基础的抗结核药物方案采用率较高(16.67% vs. 0,P=0.05)。多因素logistic回归分析提示,年龄及性别是药物性肝损伤发生的相关因素(OR=50.04,95%可信区间1.35~1 852.83,P=0.03;OR=128.36, 95%可信区间1.33~12 347.14, P=0.04)。外周血基线IgG水平升高者药物性肝损伤发生的风险亦可能升高(OR=26.38,95%可信区间0.99~706.25,P=0.05)。
    结论年龄及性别是药物性肝损伤发生的相关因素,外周血IgG水平升高者药物性肝损伤发生的风险亦可能升高。

     

    Abstract:
    ObjectiveTo ascertain the clinical characteristics and correlative factors of drug-induced liver injury caused by anti-tuberculosis drugs and explore the possible causes.
    MethodsA retrospective review was made on anti-tuberculosis drug-induced liver injury treated in Shanghai Public Health Clinical Center during 2016, focusing on demographic information, clinical data, and laboratory data. Comparisons among groups were made with t-test, Mann-Whitney test, and Fisher's exact test. Risk factors were analyzed with multivariate logistic regression.
    ResultsForty-eight patients were enrolled in the study, including eighteen drug-induced liver injury (DILI) cases and thirty controlled cases, who received anti-tuberculosis treatment. The average onset age was (36.65±21.62)years old. Among eighteen DILI cases, 72.22% were cholestatic, 5.56% hepatocellular injury, and the rest were the mixed type. Half of the DILI cases were severe ones. There were more INH+EMB combinations in DILI groups (16.67% vs 0, P=0.05). Multivariate logistic regression showed that age and gender were correlative factors of DILI (OR=50.04, 95%CI: 1.35~1 852.83, P=0.03;OR=128.36, 95%可信区间1.33~12 347.14, P=0.04) and those with higher baseline IgG level were more likely to have DILI (OR=26.38, 95%CI:0.99~706.25, P=0.05).
    ConclusionAge and gender were correlative factors of DILI and baseline IgG level probably was a correlative factor.

     

/

返回文章
返回