Clinical observation of different hepatotoxic reactions of anti-tuberculosis drugs in the liver
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摘要:
目的 观察抗结核治疗中肝毒性不同反应的临床特点。 方法 回顾性分析2018年1—12月杭州市红十字会医院90例初治肺结核患者资料，根据对抗结核药物的不同反应分为耐受组、易感组、适应组3组，每组各30例，观察其年龄、性别、基础肝病、药物过敏史、饮酒、潜伏期、恢复期、肝损伤类型、肝损伤程度等情况。 结果 耐受组、易感组与适应组年龄、基础肝病、药物过敏史比较差异均有统计学意义(F=7.193、χ2=6.398、χ2=8.580，均P＜0.05)；3组性别、饮酒比较差异均无统计学意义(χ2=1.148、2.917，均P＞0.05)。适应组潜伏期时间长于易感组[(4.39±1.24)周vs. (2.33±0.91)周]，而恢复期时间明显短于易感组[(2.28±0.90)周vs. (4.67±1.09)周]，差异均有统计学意义(t=-5.666、7.208，均P＜0.05)。2组肝损伤类型所占比例差异有统计学意义(χ2=41.429，P < 0.001)，2组肝损伤程度所占比例差异有统计学意义(U=3.506，P=0.001)。 结论 肝脏对抗结核药物的不同反应与年龄、基础肝病、药物过敏史有关，与性别及饮酒无关；易感组潜伏期短恢复慢，适应组潜伏期长恢复快，易感组以肝细胞损伤型多见，适应组以生化学检查异常为主，2组均以轻、中度肝损伤多见。 Abstract:Objective To observe the clinical characteristics of different hepatic toxicity in anti-tuberculosis treatment. Methods Retrospective analysis was performed on 90 cases of initially treated pulmonary tuberculosis in Hangzhou Red Cross Hospital. According to the different reactions of anti-tuberculosis drugs, the patients were divided into tolerance group, susceptible group and adaptive group, with 30 cases in each group. Age, gender, underlying diseases, alcohol consumption, duration of medication, type of liver injury and degree of liver injury were observed. Results The differences in age, basic liver disease and drug allergy history among the tolerance, susceptible and adaptation groups were statistically significant (F=7.193, χ2=6.398, χ2=8.580, all P < 0.05). No significant difference in gender and drinking history was found among the three groups (χ2=1.148, 2.917, all P>0.05). The incubation period of the adaptive group was significantly longer than that of the susceptible group [(4.39±1.24) weeks vs. (2.33±0.91) weeks], whereas the recovery period of the adaptive group was significantly shorter than that of the susceptible group [(2.28±0.90) weeks vs. (4.67±1.09)weeks, t=-5.666, 7.208, all P < 0.05]. The proportion of liver injury types in the two groups was significantly different(χ2=41.429, P < 0.001), and the proportion of liver injury degree in the two groups was significantly different (U=3.506, P=0.001). Conclusion The different reactions of anti-tuberculosis drugs in the liver are related to age, basic liver disease and drug allergy history but not related to gender and alcohol consumption. In the susceptible group, the short latency recovery is slow, whereas in the adaptive group, the long latency recovery is fast. In the susceptible group, hepatocyte injury is more common. In the adaptive group, biochemical abnormalities are more common. Mild and moderate liver injuries are common in both groups. -
表 1 3组肺结核患者一般资料比较
组别 例数 年龄(x±s, 岁) 性别(男/女, 例) 基础肝病(例) 药物过敏史(例) 饮酒(例) 耐受组 30 44.67±9.65 19/11 5 2 9 易感组 30 54.72±7.54 17/13 11 8 5 适应组 30 49.33±6.33 21/9 3 1 4 统计量 7.193a 1.148b 6.398b 8.580b 2.917b P值 0.002 0.563 0.031 0.014 0.233 注：a为F值，b为χ2值。 
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表 2 易感组与适应组肺结核患者肝功能变化情况比较(x±s, 周)
组别 例数 潜伏期 恢复期 易感组 30 2.33±0.91 4.67±1.09 适应组 30 4.39±1.24 2.28±0.90 t值 -5.666 7.208 P值 < 0.001 < 0.001
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表 3 易感组与适应组肺结核患者肝损伤分型比较(例)
组别 例数 生化学检查异常 肝细胞损伤型 胆汁淤积型 混合型 易感组 30 3 18 7 2 适应组 30 27 0 3 0 注：2组肝损伤类型比较，χ2=41.429，P＜0.001。
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表 4 易感组与适应组肺结核患者肝损伤程度比较(例)
组别 例数 轻度 中度 重度 肝衰竭 易感组 30 16 11 2 1 适应组 30 28 2 0 0 注：2组肝损伤类型比较，U=3.506，P=0.001。
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