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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (8): 800-804.doi: 10.3969/j.issn.1000-6621.2018.08.005

• 论著 • 上一篇    下一篇

耐药肺结核患者化疗后发生药物性肝损伤的临床特点分析

葛燕萍,张少俊,姚岚,何娅,范琳()   

  1. 200433 同济大学附属上海市肺科医院结核病临床研究中心 上海市结核病(肺)重点实验室
  • 收稿日期:2018-06-04 出版日期:2018-08-10 发布日期:2018-09-09
  • 通信作者: 范琳 E-mail:fanlinsj@163.com

Analysis of clinical characteristics in drug-resistant tuberculosis patients with drug-induced liver injury caused by chemotherapy

Yan-ping GE,Shao-jun ZHANG,Lan YAO,Ya HE,Lin FAN()   

  1. Clinic and Research Center of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
  • Received:2018-06-04 Online:2018-08-10 Published:2018-09-09
  • Contact: Lin FAN E-mail:fanlinsj@163.com

摘要:

目的 分析耐药肺结核患者化疗后发生药物性肝损伤(drug-induced liver injury,DILI)的临床特点。方法 对2008年1月1日至2014年12月31日期间入住上海市肺科医院的2767例确诊为耐药肺结核的患者进行回顾性分析,其中发生DILI患者387例,占13.99%(387/2767)。分析387例发生DILI患者中各类型耐药结核病的构成比、DILI发生的时间分布、发生DILI后对治疗转归的影响及并发病毒性肝炎对发生DILL的影响。结果 387例患者中,单耐药结核病(MR-TB)、多耐药结核病(PDR-TB)、耐多药结核病(MDR-TB)、广泛耐药结核病(XDR-TB)分别占11.63%(45/387)、27.65%(107/387)、35.14%(136/387)、25.58%(99/387)。DILI发生于抗结核药物治疗≤1个月、1~个月、2~个月、>3个月者,分别有258例(66.67%)、83例(21.45%)、17例(4.39%)、29例(7.49%)。发生DILI后,68.99%(267/387)的患者未停止抗结核药物治疗,其中MR-TB、PDR-TB、MDR-TB、XDR-TB的患者未停止治疗比率分别为73.33%(33/45)、66.36%(71/107)、69.85%(95/136)、68.69%(68/99),差异无统计学意义(χ 2=0.80,P=0.851)。发生DILI的耐药肺结核患者中,治疗成功率为47.03%(182/387),其中MR-TB、PDR-TB、MDR-TB、XDR-TB患者治疗成功率分别为53.33%(24/45)、61.68%(66/107)、47.79%(65/136)、27.27%(27/99),4类患者治疗成功率比较差异有统计学意义(χ 2=25.48,P<0.01)。并发及未并发病毒性肝炎的患者治疗成功率分别为38.52%(47/122)、50.94%(135/265),差异有统计学意义(χ 2=5.17,P=0.023)。 结论 耐药肺结核患者发生DILI以PDR-TB、MDR-TB和XDR-TB所占的比例较高。绝大部分患者DILI发生在抗结核药物治疗1~2个月内。发生DILI后对耐药肺结核整个治疗转归影响不大。并发病毒性肝炎会降低耐药肺结核的治疗成功率,在抗结核药物治疗的同时应积极进行抗病毒治疗。

关键词: 结核, 肺, 结核, 抗多种药物性, 药物性肝损伤, 疾病特征, 预后

Abstract:

Objective To analyze the clinical characteristics in drug-resistant pulmonary tuberculosis (PTB) patients with drug-induced liver injury (DILI) caused by chemotherapy.Methods A retrospective study was conducted on 2767 drug-resistant PTB patients in Shanghai Pulmonary Hospital during the period from January 1, 2008 to December 31, 2014. Of them, 387 cases occurred DILI (13.99% (387/2767)). To analyze some problems about the 387 cases. Composition of all kinds of drug-resistant PTB, the time distribution of DILI occurrence, the effect on the outcome of treatment, and whether concomitant viral hepatitis would affect the outcome of treatment or not.Results Of all the 387 patients, mono-resistance tuberculosis (MR-TB), polydrug-resistance tuberculosis (PDR-TB), multidrug-resistance tuberculosis (MDR-TB), extensive drug-resistance tuberculosis (XDR-TB) accounted for 11.63% (45/387), 27.65% (107/387), 35.14% (136/387), 25.58% (99/387), respectively. The incidences of DILI happened in ≤1 month, >1 month and ≤2 months, >2 months and ≤3 months and >3 months after anti-TB treatment were 258 (66.67%), 83 (21.45%), 17 (4.39%) and 29 (7.49%), respectively. After DILI, 68.99% (267/387) of the cases continued their anti-TB chemotherapy, the continued rate were 73.33% (33/45), 66.36% (71/107), 69.85%(95/136), 68.69% (68/99) in MR-TB, PDR-TB, MDR-TB and XDR-TB, respectively. There was no statistical difference among the four groups (χ 2=0.80, P=0.851). Of drug-resistant PTB cases with DILI, the success rate of chemotherapy was 47.03% (182/387), and the rates were 53.33% (24/45), 61.68% (66/107), 47.79% (65/136), 27.27% (27/99) in MR-TB, PDR-TB, MDR-TB and XDR-TB, respectively. Statistical difference was found among the four groups (χ 2=25.48, P<0.01). The treatment success rates of cases with and without viral hepatitis were 38.52% (47/122) and 50.94%(135/265), respectively. The difference was statistically significant (χ 2=5.17, P=0.023). Conclusion PDR-TB, MDR-TB and XDR-TB accounted for a high proportion of drug-resistant PTB with DILI cases. The majority of DILI occurred in one to two months after anti-TB treatment.DILI had little effect on the outcome of treatment. The success rate of drug-resis-tant treatment was low in concomitant viral hepatitis, therefore the anti-virus treatment should be took in time while anti-tuberculosis treatment get started.

Key words: Tuberculosis, pulmonary, Tuberculosis, multidrug-resistant, Drug-induced liver injury, Disease attributes, Prognosis