251)李胜前等抗结核药物导致肝损伤171例调查分析.doc

抗结核药物导致肝损伤171例调查分析 李胜前，杨思芸 (南充市中心医院， 四川 南充637000) 摘要：目的 调查分析抗结核药物诱导肝损伤的临床特点。方法 对2007年2月～2010年3月在南充市中心医院进行抗结核治疗患者的的肝功能情况进行调查分析。结果：符合本次调查标准的患者共456例，其中171例发生肝损伤，发生率为37.5%；在171例肝损伤患者中，152例(88.9% )发生于90天内；114例患者出现肝炎的典型表现(66.7% )， 57例患者则全无症状(33.3% ) ，只在作肝功能检查时发现异常。经治疗，156例（91.2%）患者痊愈或好转，15例（8.8%）患者未愈。结论：抗结核药物诱导肝损伤的发生率较高，对其应注意预防、早期诊断和及时合理的治疗。 关键词：抗结核药物；诱导；肝损伤；调查分析 Clinical Analysis of the Antituberculosis Drug induced Liver Injury LI Sheng-qian Yang si yun ( Nanchong Central Hospital，Nanchong Sichuan 637000，China) Abstract Objective To analyze the clinical characteristics of liver injury induced by antituberculosis drug. Methods Investigate the prevalence of the antituberculosis drug induced liver injury among tuberculosis patients treated in Nanchong center hospital during the period from February, 2007 to March, 2010. Results There were 171 (or 37.5% ) cases who were demonstrated antituberculosis drug-induced liver injury. 152 patients developed the reaction within 90 days, accounting for 88.9%. Of the 171 cases, 114 emerged related hepatitis symptoms, 57 patients were all asymptomatic, Only found abnormalities in liver function examination. 156 (91.2% ) experienced normalization or markedly improved of the liver function, 15 cases (8.8 %) patients were poor effects. Conclusion Liver injury induced by antituberculosis drugs was a severe problem which should be attentive by clinician, Its prevention, early diagnosis and proper treatment were of utmost importance and should be emphasized. Key words：Antituberculosis drug；Induced；Liver injury；Clinical Analysis 抗结核药物对肝脏有一定的毒性，特别是标准的短程化疗方案异烟肼( INH) 、利福平(RIF) 、吡嗪酰胺( PZA)三药的联合使用和全程治疗，更增加了肝脏的损害，导致临床上少数患者因肝损伤而影响或中断治疗，甚至引起暴发性肝功能衰竭死亡的风险。因此，肝损伤成为抗结核治疗中不可忽视的因素。本文对我院2007年2月～2010年3月结核患者抗结核治疗后出现肝损伤的171例患者进行调查分析，旨为抗结核药物肝损害的防治提供参考依据。 1 材料与方法 1、入选标准：2007 年2月～2010年3月在我所进行抗结核治疗的结核患者。①结核病的诊断标准参照2005年中华医学会编著的《临床诊疗指南·结核病分册》[1]②使用治疗方案：初治方案2HRZS (E) /4HR；复治方案：2HRZES/6HRE，间歇或每日疗法；或由H, R, Z, S, E,阿米卡星组成其他相应演变的治疗方案，但至少应含H、R、Z这3种药物。③ 在抗结核治疗前和抗结核治疗后至