肺结核合并糖尿病患者药物性肝损伤影响因素分析

目的: 分析肺结核合并糖尿病患者(PTB-DM)发生抗结核药物性肝损伤(anti-tuberculosis drug-induced liver injury,ATB-DILI)的影响因素。方法: 采用前瞻性队列研究的方法,连续纳入2017年10月至2019年3月青岛市中心医院北部院区符合入组标准的458例住院PTB-DM患者作为研究对象。通过自行设计的结构式调查问卷收集研究对象治疗前的年龄、性别、婚姻状况、文化水平、职业、膳食、吸烟、饮酒、体力活动水平、结核病临床症状、体质量指数、血生化指标、血常规指标、血糖控制水平、保肝药物使用及种类情况等信息;随访8个月后采用多因素Cox比例风险回归模型分析研究对象发生ATB-DILI的情况及其影响因素。结果: 458例PTB-DM患者中,53例发生ATB-DILI,发生率为11.6%。在调整了吸烟、体力活动、保肝药物使用和贫血等混杂因素后,发现血糖控制不良HR(95%CI)=2.787(1.2566.183)]、饮酒HR(95%CI)=2.159(1.097~4.251)]、消瘦(体质量指数<18.5)HR(95%CI)=2.808(1.391~5.670)]、膳食多样性不足HR(95%CI)=3.199(1.372~7.459)]是PTB-DM患者发生ATB-DILI的危险因素。结论: PTB-DM患者抗结核治疗后易发生ATB-DILI,尤其饮酒、消瘦和膳食多样性不足者,发生ATB-DILI的风险更高。

Study on influencing factors of anti-tuberculosis drug-induced liver injury in pulmonary tuberculosis patients complicated with diabetes mellitus

Objective:To analyze the influencing factors of anti-tuberculosis drug-induced liver injury(ATB-DILI)in patients with pulmonary tuberculosis complicated with diabetes mellitus(PTB-DM).Methods:A prospective cohort study was conducted to continuously enroll 458 inpatients with PTB-DM who met the enrollment criteria from October 2017 to March 2019 in the North Branch of Qingdao Central Hospital.Before their treatment,we collected information of age,gender,marital status,education level,occupation,diet,smoking,drinking,physical activity level,clinical symptoms of tuberculosis,body mass index,blood biochemical index,blood routine index,blood glucose control level,usage and types of liver protection drugs through a self-designed structured questionnaire;after following-up for eight months,a multivariate Cox proportional hazard regression was done to analyze the occurrence of ATB-DILI and its influencing factors.Results:Among 458 PTB-DM patients,53 patients developed ATB-DILI,with an incidence rate of 11.6%.After adjusting for confounding factors such as smoking,physical activity,liver protection drugs and anemia,it was found that poor glycemic control(HR(95%CI)=2.787(1.256-6.183)),drinking(HR(95%CI)=2.159(1.097-4.251)),low weight(body mass index<18.5)(HR(95%CI)=2.808(1.391-5.670))and insufficient dietary diversity(HR(95%CI)=3.199(1.372-7.459))were risk factors for ATB-DILI in PTB-DM patients.Conclusion:Patients with PTB-DM were prone to develop ATB-DILI after anti-tuberculosis treatment,especially for those who had drinking habits,with low weight and inadequate dietary diversity,they were associated with a higher risk of ATB-DILI.