Drug-induced hepatitis and the risk factors for liver injury in pulmonary tuberculosis patients.
Drug-induced hepatitis and the risk factors for liver injury in pulmonary tuberculosis patients.
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DOI：
10.4103/2249-4863.154661
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发表时间：
2015-04
影响因子：
1.4
通讯作者：
Hattiholi J
中科院分区：
文献类型：
--
作者：
Gaude GS;Chaudhury A;Hattiholi J
含利福平和异烟肼的短程化疗联合治疗结核病已被证明是非常有效的，但其不良反应之一是肝毒性。在一般人群中，已发现多种危险因素与药物性肝损伤（DILI）相关。该研究旨在确定印度肺结核患者中药物性肝炎的患病率以及与DILI相关的危险因素。前瞻性巢式病例对照研究。在3900例开始抗结核治疗的结核病患者中，150例因RNTCP短程化疗而发生药物性肝损伤的患者被纳入分析。30例在我院随访，其他120例由基层卫生中心转介给我们进行药物性肝炎的管理。DILI的诊断标准根据美国胸科学会标准制定。对DILI发生的各种危险因素进行了分析。本研究中DILI的患病率为3.8%。据观察，DILI患者年龄较大，血清白蛋白水平较低，且有多种共病。定期饮酒、与放射学相关的更广泛的疾病和女性被观察到是DILI发展的独立危险因素。在分析的各种风险因素中，高龄、低白蛋白血症、定期饮酒和疾病的晚期性质是DILI发展的独立风险因素。在存在一种或多种这些风险因素的情况下，发生肝炎的风险增加。
Short-course chemotherapy containing rifampicin and isoniazid in combination has proved to be highly effective in the treatment of tuberculosis, but one of its adverse effects is hepatotoxicity. Various risk factors have been found to be associated with drug-induced liver injury (DILI) in general population. The study aimed to determine the prevalence of drug-induced hepatitis and the risk factors associated with the DILI among the patients of pulmonary tuberculosis in Indian patients. Prospective nested case control study. Out of the cohort of 3900 tuberculosis patients who were initiated on anti-tubercular therapy, 150 patients who developed drug-induced liver injury due to short-course chemotherapy under RNTCP were included in the analysis. Thirty cases were being followed up in our hospital and other 120 were referred to us for the management of drug-induced hepatitis from the primary health centers. The diagnostic criteria's for DILI were made according to the American Thoracic Society criteria. Analyses of various risk factors were done for the development of DILI. The prevalence of DILI in the present study was 3.8%. It was observed that DILI patients were older and their serum albumin levels were lower, and they had multiple co-morbid conditions. Regular alcohol intake, more extensive disease associated with radiological and female gender were observed to be independent risk factors for the development of DILI. Of the various risk factors analyzed, advanced age, hypoalbuminemia, regular alcohol intake and advanced nature of the disease were independent risk factors for the development of DILI. The risk of development of hepatitis is increased in the presence of one or more of these risk factors.