抗结核治疗后脂肪肝形成的临床观察

目的：探讨抗结核药物所致脂肪肝（Fattyliver）和药物性肝损害（Drug—inducedliverinju—ry，DILI）的发生机理。方法：选取200例结核病患者为研究对象，分别于抗结核治疗前、后进行肝功能、血脂监测，治疗前、后均行肝区CT扫描。结果：抗结核治疗后脂肪肝发生率为28．OO％（56／200），DILl的发生率为32．00％（64／200）。血清ALT、AST水平均高于治疗前（P〈0．05）。其中ALT在治疗后的第1、2、3个月、AST在治疗后的第1、2、3、4个月升高最为明显，差异有统计学意义（P〈0．01）。TG、高密度脂蛋白胆固醇（HDI。一C）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白B（apoB）水平均显著高于治疗前（均P〈0．05）。其中TG在治疗后的第2、3、4个月，LDL—C在第3、4个月，apoB在第1、2、3、4、5个月升高最为明显（均P〈0．01）。血清ALT、AST升高均与TO、apoB、HDL—C、LDL-C呈显著正相关（P〈0．05，P〈0．01）。结论：抗结核治疗中脂肪肝的形成提示DILI已发生。加强肝功能、血脂指标的监测可减少、减轻DILI的发生，防止脂肪肝形成，保证抗结核治疗方案的顺利实施。

Clinical observation of the formation of fatty liver after anti-tubercu- losis treatment

AIM： To understand the Occur rence mechanism of the anti-tuberculosis drug- induced fatty liver and drug-induced liver injury （DILI）. METHODS： 200 tuberculosis（TB） pa tients were received, liver function and serum lipid were monitored before and after anti-TB treatment, underwent X-ray computer tomo-graphy scan fatty liver before and complete treatment. The experimental data were treated statistically. RESULTS： The incidence of fatty liver was 28.00% （56/200） and the incidence of DILI was 32.00%（64/200） after treatment. The serum ALT, AST levels after treatment were higher than those before treatment （ P〈 0.05）. The ALT levels after treatment in first, second, third months, AST levels after treat ment in first, second, third ,fourth months was the most statistically significant difference than before treatment （P 〈 0.01）. TG, HDL-C, LDL-C, apoB levels were significantly higherthan that before treatment （P〈0.05）. The TG levels after treatment in second, third, fourth months, LDL-C levels after treatment in third, fouth months, apoB in first, second, third, fourth, fifth months was the most significant than before treatment （P〈0.01）. The increase of ALT, AST levels in the serum were signifi cantly postive correlation with the levels of TG, apoB, HDL-C, LDL-C （P〈0. 05,P〈0. 01）. CONCLUSION： The formation of fatty liver sug gests DILl has undergone in anti-tuberculosis treatment. To strengthen the monitoring of blood lipid indexes can, reduce the occurrence of DILI, prevent the formation of fatty liver, en sure the implementation scheme in treatment of tuberculosis.