抗结核药致中国人群药物性肝损伤危险因素的Meta分析

摘要：目的 系统评价中国人群使用抗结核药致药物性肝损伤的危险因素。方法 检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库以及维普数据库(VIP)中建库至2019年10 月发表的有关中国人群使用抗结核药致药物性肝损伤的研究文献，2名研究员独立按照纳入与排除标准筛选文献、提取资料及 质量评价后，采用RevMan 5.3软件进行Meta分析。结果 共纳入12篇文献，均为中文文献，纳入8216例患者，共筛选出13种 暴露因素。Meta分析结果显示，嗜酒(OR=2.54，95%CI：1.97~3.27)、肝病史(OR=2.60，95%CI：2.19~3.08)、乙肝表面抗原携 带者(OR=3.15，95%CI：2.66~3.73)、糖尿病(OR=1.41，95%CI：1.18~1.70)、心功能不全(OR=1.72，95%CI：1.28~2.30)、贫血 (OR=4.61，95%CI：2.43~7.90)、营养不良(OR=2.48，95%CI：1.63~3.77)和结核病复治(OR=1.93，95%CI：1.43~2.60)是抗结核 药物致肝损伤的危险因素(P<0.05)。预防性予以保肝药能显著减少抗结核药致肝损伤的发生率(OR=0.36，95%CI：0.25~0.50， P<0.001)。结论 贫血、乙肝表面抗原携带者、合并其他肝病史、嗜酒、营养不良、结核病复治、心功能不全、糖尿病是我国 人群使用抗结核药致肝损伤的危险因素。对于有高危因素的患者予以保肝药能显著降低抗结核药致肝损伤的发生率。

Meta-analysis on risk factors for antituberculosis drug-induced liver injury (ADILI) in Chinese patients

Abstract Objective To systematically assess risk factors for antituberculosis drug-induced liver injury (ADILI) in Chinese patients. Methods Literatures were retrieved from PubMed，Embase, Cochrane Library, CNKI,CBM,Wanfang and VIP database from the establishment of database to May of 2019, and the data about the risk factors for ADILI in Chinese patients were collected．Literatures were screened,extracted,and evaluated according to inclusion and exclusion criteria by two reviewers. Meta-analysis was conducted using RevMan 5.3 software．Results A total of 12 literatures were included, all of which were Chinese literatures, including 8216 patients. A total of 13 exposure factors were screened. Meta-analysis showed that alcoholism (OR=2.54, 95% CI: 1.97~3.27), history of liver disease (OR=2.60, 95%CI: 2.19~3.08), carrier of hepatitis B antigen (OR=3.15, 95% CI: 2.66~3.73), diabetes (OR=1.41, 95%CI: 1.18~1.70), cardiac insufficiency (OR=1.72, 95%CI: 1.28~2.30), anemia(OR=4.61, 95%CI: 2.43~7.90), malnutrition (OR=2.48, 95%CI: 1.63~3.77), and tuberculosis retreatment (OR=1.93, 95%CI: 1.43~2.60) were risk factors for ADILI in Chinese patients(P<0.05). Prophylactic hepatoprotective drugs could significantly reduce the incidence of liver damage caused by anti-tuberculosis drugs (OR=0.36, 95%CI: 0.25 ~0.50, P<0.001). Conclusion Anemia, hepatitis B original antigen carrier, combined with other liver disease history, alcoholism, malnutrition, tuberculosis retreatment, cardiac insufficiency, diabetes are risk factors for ADILI in Chinese patients. Hepato protective drugs for patients with high risk factors can significantly reduce the incidence of liver damage caused by anti-tuberculosis drugs.