摘要目的 探讨抗结核药致肝衰竭发生及预后的危险因素.方法 回顾性分析2012年1月至2016年6月本院收治的服用抗结核药致药物性肝损伤的343例患者的临床资料,分析性别、年龄、体质量指数、潜伏期、抗结核方案、慢性HBV携带、HBV DNA、丙型肝炎、戊型肝炎、肝硬化、糖尿病、高血压、脂肪肝、饮酒史、人工肝治疗、药物性肝损伤分型等因素对抗结核药致肝衰竭的发生及预后的影响.结果 多因素Logistic回归分析显示,年龄(OR=1.964,95%CI:1.112~3.468)、慢性HBV携带(OR=1.922,95%CI:1.068~3.457)、戊型肝炎(OR=2.481,95%CI:1.198~5.139)、肝硬化(OR=9.327,95%CI:4.248~20.481)是服用抗结核药物导致肝衰竭发生的危险因素(均P<0.05);年龄(OR=4.329,95%CI:1.636~11.456)、慢性HBV携带(OR=4.329,95%CI:1.636~11.456)是药物性肝衰竭预后的危险因素(均P<0.05).结论 年龄≥45岁、有慢性HBV携带、有戊型肝炎及存在肝硬化的患者在抗结核治疗过程中发生药物性肝损伤后更容易进展为肝衰竭,且年龄≥45岁及慢性HBV携带者肝衰竭的预后可能较差.

abstractsObjective To investigate the risk factors for the occurrence and prognosis of liver failure induced by anti-tuberculosis drugs. Methods The clinical data of 343 patients with drug-induced liver injury caused by anti-tuberculosis drugs,who were hospitalized in our hospital between January 2012 and June 2016,were retrospectively analyzed. The effects of gender,age,body mass index,incubation period,anti-tuberculosis treatment protocol,chronic HBV carriers,HBV DNA,hepatitis C,hepatitis E, liver cirrhosis,diabetes,hypertension,fatty liver,alcohol history,artificial liver treatment,classification of drug-induced liver injury for the occurrence and prognosis of liver failure induced by anti-tuberculosis drugs were analyzed. Results Multivariate Logistic regression analysis showed that age (OR=1.964,95%CI:1.112-3.468),chronic HBV carriers(OR=1.922,95%CI:1.068-3.457),hepatitis E(OR=2.481,95%CI:1.198-5.139),liver cirrhosis(OR=9.327,95%CI:4.248-20.481)were the risk factors for the occurrence of liver failure induced by anti-tuberculosis drugs(all P<0.05);the age(OR=4.329,95%CI:1.636-11.456) and chronic HBV carriers(OR=4.329,95%CI:1.636-11.456)were the risk factors for the prognosis of drug-induced liver failure(all P<0.05). Conclusion Patients aged ≥45 years old,chronic HBV carriers,and patients with hepatitis E and liver cirrhosis are more likely to develop liver failure after drug-induced liver injury during anti-tuberculosis treatment,and the prognosis of liver failure in patients aged≥45 years old and chronic HBV carriers may be poor.