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Chinese Journal of Antituberculosis ›› 2018, Vol. 40 ›› Issue (8): 800-804.doi: 10.3969/j.issn.1000-6621.2018.08.005

• Original Articles • Previous Articles     Next Articles

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

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