Antituberculosis drug-induced hepatotoxicity - The role of hepatitis C virus and the human immunodeficiency virus
Antituberculosis drug-induced hepatotoxicity - The role of hepatitis C virus and the human immunodeficiency virus
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DOI：
10.1164/ajrccm.157.6.9711039
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发表时间：
1998-06-01
影响因子：
24.7
通讯作者：
Pitchenik, AE
中科院分区：
文献类型：
--
作者：
Ungo, JR;Jones, D;Pitchenik, AE
直到最近，人们还认为年龄大于 35 岁是接受抗结核治疗的患者发生药物性肝炎 (DIH) 的主要危险因素。我们进行了一项研究，以确定丙型肝炎病毒或人类免疫缺陷病毒 (HIV) 感染是否是接受抗结核治疗的患者发生 DIH 的重要危险因素。我们的研究由两部分组成。第一部分对 134 名因结核病 (TB) 治疗而入院的连续患者进行了 DIH 进展情况的随访。所有这些患者还接受了丙型肝炎和艾滋病毒筛查。在研究的第二部分中，对那些丙型肝炎阳性且因反复重新使用抗结核药物而发生 DIH 的患者进行了肝活检。如果活检标本上存在可能提示丙型肝炎感染的活动性炎症，则开始使用α-干扰素治疗，随后重新使用抗结核药物。在为期 18 个月的研究中，22 名患者出现了 DIH。如果患者是丙型肝炎或 HIV 阳性，发生 DIH 的相对风险分别是五倍和四倍 (p < 0.05)。如果患者同时感染丙型肝炎和 HIV，则发生 DIH 的相对风险会增加 14.4 倍 (p < 0.002)。在治疗部分，4名患者接受了α-干扰素治疗，所有患者都能够重新接受抗结核治疗，并且没有再次出现DIH。丙型肝炎和 HIV 感染是结核病治疗期间发生 DIH 的独立且附加的危险因素。使用α-干扰素治疗丙型肝炎可以使那些因接触这些药物而出现 DIH 的患者重新使用抗结核药物。
Until recently it was thought that age greater than 35 yr was the main risk factor for the development of drug-induced hepatitis (DIH) in patients receiving antituberculosis therapy. We conducted a study to determine whether infection with either the hepatitis C virus or the human immunodeficiency virus (HIV) were significant risk factors for the development of DIH in patients receiving antituberculosis therapy. Our study consisted of two parts. In the first part, 134 consecutive patients admitted for the treatment of tuberculosis (TB) were followed for the development of DIH. All of these patients were also screened for the presence of hepatitis C and HIV. In the second part of the study, those patients who were hepatitis C positive and who developed DIH on repeated reintroduction of the anti-TB drugs were offered a liver biopsy. If active inflammation, which may be suggestive of hepatitis C infection, was present on the biopsy specimen, treatment with alpha-interferon was begun and the anti-TB drugs were subsequently reintroduced. During the 18 mo of the study, 22 patients developed DIH. The relative risk of developing DIH if the patient was hepatitis C or HIV positive was fivefold and fourfold, respectively (p < 0.05). If a patient was coinfected with both hepatitis C and HIV the relative risk of developing DIH was increased 14.4-fold (p < 0.002). In the treatment part, four patients were treated with alpha-interferon, and all were able to undergo the reintroduction of anti-TB therapy without reoccurrence of DIH. Infection with hepatitis C and HIV are independent and additive risk factors for the development of DIH during TB therapy. The treatment of hepatitis C with alpha-interferon may allow the reintroduction of anti-TB agents in those who previously developed DIH when exposed to these drugs.