Incidence, Clinical and Epidemiological Risk Factors, and Outcome of Drug-Induced Hepatitis Due to Antituberculous Agents in New Tuberculosis Cases
Incidence, Clinical and Epidemiological Risk Factors, and Outcome of Drug-Induced Hepatitis Due to Antituberculous Agents in New Tuberculosis Cases
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DOI：
10.1097/mjt.0b013e31818f9eae
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发表时间：
2010-01-01
影响因子：
4.2
通讯作者：
Masjedi, Mohammadreza
中科院分区：
文献类型：
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作者：
Baghaei, Parvaneh;Tabarsi, Payam;Masjedi, Mohammadreza
药物性肝炎（DIH）是结核病（TB）治疗中的一个重要问题。我们打算评估抗结核药物引起肝炎的发病率、危险因素和结果。这项研究是在2006-2008年国家结核病转诊中心进行的，包括所有记录在案的结核病新病例。所有患者均接受标准抗结核治疗。如果发生DIH，则停用所有药物，并在肝功能检查（LFT）逐步恢复正常后重新开始。在761例患者中，99例（13.0%）患者在抗结核治疗期间发生DIH。肝炎组与对照组在性别、民族、吸烟史、阿片类药物使用史等方面差异无统计学意义（P > 0.05）。DIH在65岁以上的患者中显著更高（P = 0.019）。DIH从治疗开始的平均持续时间为17.53 ± 19.42天（中位数= 12; 1-125天）。此外，从DIH到（LFF）正常化的平均时间为10.26 +/- 5.95（中位数= 9; 0-32天）。厌食、恶心、呕吐、腹痛、黄疸、腹泻、意识水平下降和发热在DIH患者中明显更高。DIH组死亡13例（13.4%），对照组死亡21例（3.2%），差异有统计学意义（P < 0.001，95%可信区间= 2.26-9.70，OR = 4.7）。经Logistic回归调整后，所有预期因素均具有统计学意义。我们的研究表明，DIH最常发生在抗结核治疗的前2周。DIH的发生与年老、某些临床表现和较高的死亡率有关。
Drug-induced hepatitis (DIH) is an important issue in tuberculosis (TB) treatment. We intend to assess the incidence, risk factors, and outcome of hepatitis due to anti-TB drugs. The study is carried out at the national TB referral center 2006-2008 including all documented new cases of TB. All patients received standard anti-TB treatment. If DIH occurred, all drugs were discontinued and reinitiated after liver function tests (LFT) normalization in a stepwise way. Of total 761 patients, 99 (13.0%) patients developed DIH during anti-TB treatment. There was no difference in sex, nationality, smoking, or opium use history between the hepatitis group and the control group (P > 0.05). DIH was significantly higher in patients older than 65 years (P = 0.019). The mean duration of DIH from the beginning of treatment was 17.53 +/- 19.42 days (median = 12; 1-125 days). Also, the mean of the time elapsed from DIH till the (LFF) normalization was 10.26 +/- 5.95 (median = 9; 0-32 days). Anorexia, nausea, vomiting, abdominal pain, jaundice, diarrhea, decreased level of consciousness, and fever were significantly higher in patients with DIH. In DIH group, 13 patients (13.4%) died, whereas in the control group, death occurred just in 21 cases (3.2%) (P < 0.001, 95% confidence interval = 2.26-9.70, odds ratio = 4.7). After adjusting with logistic regression, all the anticipated factors retained the statistical significance. Our study indicated that DIH most often occurs during the first 2 weeks of anti-TB treatment. DIH development is associated with old age, certain clinical manifestations, and higher death rates.