抗结核药物对高危险因素人群肝损害分析

目的探讨抗结核药物对高危险因素人群肝损害的特点。方法选取2009年1月-2010年12月结核病防治科抗结核治疗128例存在高危因素人群患者,依据治疗过程中是否采用护肝治疗措施分为未干预组63例,干预组65例,比较两组患者在抗结核治疗中出现药物性肝损害的时间及临床症状的差异,对比两组间肝损害发生率、肝损情况、引起肝损的原因。结果未干预组肝损害发生率及肝功能受损害程度较干预组高,差异有统计学意义（P〈0.05）。两组引起药物性肝损的原因中以利福平为主,出现药物性肝损的时间高峰为服药4周以内、而引起肝损的三种药物的构成比差异无统计学意义（P〉0.05）。结论对于老年人、长期饮酒者、乙肝病毒感染者、营养不良等高危险因素人群抗结核治疗时给予干预方案,可以减少肝损发生。

Analysis on Antitubercular Drugs - induced Liver Damage in High - risk Population

Objective To explore the characteristics of antitubercular drugs-induced hepatic damage among high-risk population. Methods Totally 128 tuberculosis patients with high-risk factors who received antitubercular medication in TB Prevention and Cure Division from January 2009 to December 2010 were enrolled in the study.According to receiving or not receiving liver protection medication during the course of the treatment,all the patients were divided into intervention group(n=65) and non-intervention group(n=63).The difference among the occurring time of liver damage and clinical manifestations during the course of antitubercular medication,the incidence rate of hepatic damage,the condition of hepatic injury,and the culprit for causing liver damage were compared between the two groups. Results The incidence rate of damage and the severity of liver dysfunction in non-intervention group were higher than those in intervention group,and the difference was statistically significant(P<0.05).Rifampicin was the main culprit for drug-induced hepatic injury in the two groups.The peak time of hepatic injury occurred during a 4-week medication period.But no statistically significant difference was found in the constituent ratio of three drugs induced hepatic injury(P>0.05). Conclusions Implementing interventions during the period of antituberculosis treatment can reduce the incidence of hepatic injury for the high-risk population, including the elderly,long-term drinkers,HBV patients,malnutrition persons,etc.