抗结核药物致肝损害的相关因素分析

目的：探讨抗结核药物致肝损害的相关因素。方法：回顾性分析本院自2010年1月-2013年8月收治的1538例结核病患者的临床资料，分析抗结核药物致肝损害的因素，其中包括患者的性别、年龄、种族、糖尿病史、饮酒史、HBsAg、结核类型以及肝炎史等方面。结果：本组1538例患者中，发生轻度肝损伤154例（10．01％），中度肝损伤45例（2．93％），重度肝损伤25例（1．63％），总损伤224例（14．56％）。HBsAg呈现阳性的患者发生肝损伤的几率明显高于阴性者，有糖尿病史和肝炎史患者发生肝损伤几率明显高于无糖尿病史和肝炎史，有饮酒史的患者发生药物性肝损伤的几率要明显高于无饮酒史患者，进行过预防性保肝治疗的患者其患病率明显低于没有进行过治疗的患者，营养状况的好坏也与患者患病的几率有关，差异有统计学意义（P〈0．05）。结论：在进行抗结核药物治疗时，应充分了解患者的病情、病史等，选择对患者危害性较小的抗结核药物，并采取适当的护肝措施，以尽可能减少药物性肝损害的发生，保证抗结核治疗的顺利进行。

Analysis of Related Factors of Liver Damage Caused by Anti Tuberculosis Drugs

Objective： To investigate the related factors liver damage caused by anti tuberculosis drugs. Method： The clinical data of 1538 tuberculosis patients in our hospital from January 2010 to August 2013 were retrospectively analyzed, the factors of liver damage caused by anti tuberculosis drugs were analyzed, including gender, age, race, diabetes history, drinking history, HbsAg, tuberculosis type and hepatitis history etc of patients. Result： In 1538 patients, the occurrence of mild liver injury in 154 cases （ 10.01% ）, 45 cases of moderate liver injury （ 2.93% ）, severe liver injury in 25 cases （ 1.63% ）, the total injury in 224 cases （ 14.56% ） .The probability of occurrence of liver injury in HBsAg positive patients was significantly higher than that of negative, the probability of occurrence of liver injury in patients with diabetes history and hepatitis history were significantly higher than those in patients with no diabetes history and hepatitis history, the probability of occurrence of drug-induced liver injury in patients with drinking history was significantly higher than that in patients with no drinking history, prevalence rate of liver patients with preventive treatment was significantly lower than not treated patients, there was a relationship between risk and nutritional status of the patients with good or bad, the differences were statistically significant （P〈0.05） .Conclusion： When the treatment with anti-tb drugs, we should fully understand the patient＇s condition, history, etc, chooselessharmful antitb drugs to patients, and take the appropriate measures to the occurrence of liver protecting, as far as possible to reduce drug-induced liver injury, guarantee the anti tuberculosis therapy smoothly.