Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis
Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis
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DOI：
10.1183/09031936.96.09102026
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发表时间：
1996-10-01
影响因子：
24.3
通讯作者：
Lode, H
中科院分区：
文献类型：
--
作者：
Schaberg, T;Rebhan, K;Lode, H
本研究的目的是确定因肺结核住院的患者中目前严重到足以导致对异烟肼、利福平和吡嗪酰胺标准抗结核治疗不耐受的副作用的发生率。对一所教学胸科医院感染性疾病科的 519 例确诊肺结核且最初接受标准抗结核治疗的患者进行了回顾性研究。对导致最终终止三种标准药物之一的治疗相关严重副作用的发生率进行了测量，并分析了不耐受的危险因素。519 名患者中有 121 名 (23%) 因严重副作用而需要最终终止异烟肼、利福平或吡嗪酰胺。导致最终终止使用一种药物的最严重副作用是肝毒性（11%）、皮疹（6%）和关节痛（2%）。吡嗪酰胺的副作用 (15%) 比异烟肼 (7%) 和利福平 (1.5%) 更严重。多变量分析后，标准治疗不耐受的重要危险因素是肝炎病史（比值比 (OR) 3.4；95% 置信区间 (95% CI) 1.6-7.6；p=0.0026）和年龄大于或等于 60 岁（OR 1.9；95% CI 1.2-3.2；p=0.017）。这两个危险因素也与吡嗪酰胺的不耐受显着相关（肝炎史：OR 2.5；95% CI 1.4-4.3；p=0.0045；年龄大于或等于 60 岁：OR 2.1，95% CI 1.3-3.5；p=0.0029），但与异烟肼和利福平无关。年龄大于或等于 60 岁或有既往肝炎病史的住院患者经常接受抗结核治疗，并且可能是由于吡嗪酰胺而不是异烟肼或利福平。
The aim of this study was to determine the current incidence of side-effects severe enough to cause intolerance of standard antituberculosis therapy with isoniazid, rifampin and pyrazinamide in patients hospitalized as a result of pulmonary tuberculosis.Five hundred and nineteen patients with proven pulmonary tuberculosis, who initially received standard antituberculosis therapy, were retrospectively studied in the department of infectious diseases in a teaching chest hospital. The incidence of severe side-effects related to the therapy, which led to the definitive termination of one of the three standard drugs, was measured and the risk factors for intolerance were analysed.Final termination of either isoniazid, rifampin or pyrazinamide because of severe side-effects was necessary in 121 of the 519 patients (23%). The most severe side-effects leading to final termination of one drug were hepatotoxicity (11%), exanthema (6%), and arthralgia (2%). Pyrazinamide showed more severe side-effects (15%) than isoniazid (7%) and rifampin (1.5%), Significant risk factors for intolerance of the standard therapy following a multivariate analysis were a history of hepatitis (odds ratio (OR) 3.4;95% confidence interval (95% CI) 1.6-7.6; p=0.0026) and an age greater than or equal to 60 yrs (OR 1.9; 95% CI 1.2-3.2; p=0.017). Both of these risk factors were also significantly associated with the intolerance of pyrazinamide (history of hepatitis: OR 2.5; 95% CI 1.4-4.3; p=0.0045; age greater than or equal to 60 yrs: OR 2.1, 95% CI 1.3-3.5; p=0.0029) but not of isoniazid and rifampin.The side-effects of standard antituberculosis therapy are frequent in hospitalized patients aged greater than or equal to 60 yrs or with a history of previous hepatitis, and are probably due to pyrazinamide rather than to isoniazid or rifampin.