药物性肝损害高危人群抗结核治疗方案的探讨

目的 探讨具有药物性肝损害高危因素患者采取提前干预措施（适当调整强化期化疗方案），对药物性肝损害的发生及强化期痰菌转阴率的影响。方法回顾性调查我院1996年1月1日—2006年12月31日收治的初治菌阳且存在发生药物性肝损害高危险因素的肺结核患者243例。对比观察采取与未采取提前干预措施2组患者，药物性肝损害的发生率及痰菌转阴率。结果采取干预措施126例，其中出现肝损害11例（11/126，8.7%），非干预117例，其中出现肝损害42例（42/117，35.9%），对比2组肝损害发生率，干预组明显低于非干预组（P＜0.01）。2个月痰涂片抗酸杆菌转阴率分别为62.7%（79/126）和64.1%（75/117），差异无统计学意义（P＞0.05）。结论对存在发生药物性肝损害高危险因素的初治菌阳肺结核患者，如老年患者、病毒性肝炎患者及病毒携带者、营养不良、脂肪肝、嗜酒者等，应用抗结核药物时应提前采取适当干预措施，根据患者不同情况调整强化期化疗方案。

Study on anti-tuberculosis therapeutic regimen in patients with high risk factors of drug-induced hepatitis

Objective To evaluate the effect on drug-induced hepatitis in patients with pulmonary tuberculosis and potential drug-induced hepatitis and its sputum smear negative conversion with interfered measures when anti-tuberculosis agent was given. Methods This retrospective study including 243 patients, who hospitalized in our hospital from January 1, 1996 to December 31, 2006, with initial treatment smear positive pulmonary tuberculosis and with potential drug induced hepatitis was performed. The incidence of drug induced hepatitis and the rate of sputum smear negative conversion were analyzed between the group patients with interfered measures and another group patients without interfere measures when they were given with first line anti-tuberculosis agent. Results There were only 11 patients associated with drug induced hepatitis in 126 patients with interfered measures when given with anti-tuberculosis agent. However, 42 patients associated with drug induced hepatitis in 117 patients without interfered measures when given with anti-tuberculosis agent. The rate of drug induced hepatitis among the group patients with interfered measures was lower than that of group patients without interfered measures with statistically significant difference （P〈0.01）. But the rate of sputum smear negative conversion after two months treatment were 62.7%（79/126） and 64.1%（75/117） between two group patients with no statistically significant difference（P〉0.05）. Conclusions Interfered measures should be performed in advance to patients with pulmonary tuberculosis associated with high risk factor of drug induced hepatitis, such as the elderly, and patients with virus hepatitis, hepatitis virus carrier, malnutrition, fatty liver, alcohol addiction.