抗结核药物对慢性肝病肺结核患者肝功能的影响

目的 探讨2HRZE/4HR方案对患不同慢性肝病的肺结核患者肝功能的影响.方法 回顾性分析2004年8月～2005年8月住院期间收治的1475例初治肺结核患者在化疗过程中发生肝功能损害的临床资料.B超检查提示同时患有慢性肝病者(脂肪肝、肝硬化等)为观察组(136例);未患肝病者为对照组(1339例).结果 观察组有57例(41.9%)出现了肝损害,其中脂肪肝12例(60.0%),肝硬化7例(87.5%),慢性酒精性肝病6例(35.7%),慢性乙型肝炎9例(45.0%),慢性血吸虫病肝8例(50.0%),肝血管瘤或肝囊肿10例(26.3%),肝内胆管结石5例(25.0%).对照组出现肝损害138例(10.3%).观察组肝功能损害比对照组严重.观察组经护肝治疗肝功能的恢复也比对照组慢.结论 2HRZE/4HR方案对各类慢性肝病的肺结核患者肝功能损害较大,发生较早,恢复较慢.应尽量选用对肝脏损害小的药物,并密切监测肝功能,同时给予有效的护肝治疗.

Analysis on liver damage caused by anti-tuberculosis drugs for pulmonary tuberculosis combined with chronic liver diseases

Objective To study the effect of anti-tuberculosis treatment regimen with 2HRZS/4HR on liver functions in the tuberculosis patients combined with chronic liver diseases.Methods 1475 pulmonary tuberculosis patients,who had been treated with the regimen of 2HRZS/4HR,were retrospectively analyzedfrom August 2004 to August 2005.They were separated into two groups by sonography:136 with chronic liver diseases(observational group)and 1339 without chronic liver diseases(control group).Results There were 57 cases who had liver damage in observational group(41.9%):12 cases with fatty liver(60.0%),7 cases with hepatic cirrhosis(87.5%),6 cases with alcoholic liver disease(35.7%),9 cases with chronic hepatitis B(45.0%),8 cases with hepatic schistosomiasis(50.0%),10 cases with liver hemangiomas or hepatic cyst,5 cases with calculus of intrahepatic duct(25.0%).There were 138 cases with liver damage in control group(10.3%).The difference between them was significant.The recovery rate of liver function in observational group was also lower than that in control group.Conclusion The side-effect of the anti-tuberculosis with 2HRZS/4HR regimen should be figured out earlier and measure of prevention should be taken so that the period of Tuberculosis treatment coursewould be successfully completed.The incidence of liver injury in tuberculosis patient combined with chronic liver disease who received the anti-tuberculosis regimenof 2HRZS/4HR is high.It occurs early and restores slowly.In the anti-tuberculosis therapy course,it is necessary to monitor the patient's liver function in a short period and take actions to protect it.