Incidence, clinical features and impact on anti-tuberculosis treatment of anti-tuberculosis drug induced liver injury (ATLI) in China.
Incidence, clinical features and impact on anti-tuberculosis treatment of anti-tuberculosis drug induced liver injury (ATLI) in China.
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DOI：
10.1371/journal.pone.0021836
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Zhan S
中科院分区：
文献类型：
--
作者：
Shang P;Xia Y;Liu F;Wang X;Yuan Y;Hu D;Tu D;Chen Y;Deng P;Cheng S;Zhou L;Ma Y;Zhu L;Gao W;Wang H;Chen D;Yang L;He P;Wu S;Tang S;Lv X;Shu Z;Zhang Y;Yang Z;Chen Y;Li N;Sun F;Li X;He Y;Garner P;Zhan S
抗结核药物引起的肝损伤（ATLI）正在成为中国结核病控制的一个重大威胁，尽管关于ATLI在人群水平上的负担的数据有限。本研究旨在估计ATLI的发病率，更好地了解其临床特征，并评估其对中国抗结核（TB）治疗的影响。在一项基于人群的前瞻性研究中，我们监测了4,304名接受直接观察治疗策略（DOTS）治疗的结核病患者，发现106名患者发生ATLI，累积发病率为2.55%（95%置信区间[CI]， 2.04%-3.06%）。恶心、呕吐和厌食是最常见的三个症状。ATLI患者无症状35例（33.02%），其中重度肝毒性8例。ATLI的预后方面，恢复84例（79.25%），好转18例（16.98%），治疗无效2例（1.89%），血清丙氨酸转氨酶持续升高，2例（1.89%）死于ATLI。在所有ATLI病例中，74例（69.81%）改变了抗结核治疗方案，其中改变给药方式4例（3.77%），更换药物21例（19.81%），中断治疗54例（50.94%），停止治疗12例（11.32%）。治疗结果方面，及时治愈53例（51.46%），延长治疗48例（46.60%），死亡2例（1.94%）。与非ATLI患者相比，ATLI患者抗结核治疗结果失败的风险为9.25倍（95%CI, 5.69-15.05），强化治疗期延长的风险为2.11倍（95%CI, 1.23-3.60）。ATLI可以显著影响抗结核治疗的结果。鉴于ATLI的发病率和中国结核病人口的规模，其负面影响是巨大的。因此，需要更多的研究和努力，以提高ATLI的诊断和预防。
Anti-tuberculosis drug induced liver injury (ATLI) is emerging as a significant threat to tuberculosis control in China, though limited data is available about the burden of ATLI at population level. This study aimed to estimate the incidence of ATLI, to better understand its clinical features, and to evaluate its impact on anti-tuberculosis (TB) treatment in China. In a population-based prospective study, we monitored 4,304 TB patients receiving directly observed treatment strategy (DOTS) treatment, and found that 106 patients developed ATLI with a cumulative incidence of 2.55% (95% Confidence Interval [CI], 2.04%–3.06%). Nausea, vomiting and anorexia were the top three most frequently observed symptoms. There were 35 (33.02%) ATLI patients with no symptoms, including 8 with severe hepatotoxicity. Regarding the prognosis of ATLI, 84 cases (79.25%) recovered, 18 (16.98%) improved, 2 (1.89%) failed to respond to the treatment with continued elevation of serum alanine aminotransferase, and 2 (1.89%) died as result of ATLI. Of all the ATLI cases, 74 (69.81%) cases changed their anti-TB treatment, including 4 (3.77%) cases with medication administration change, 21 (19.81%) cases with drugs replacement, 54 (50.94%) cases with therapy interruption, and 12 (11.32%) cases who discontinued therapy. In terms of treatment outcomes, 53 (51.46%) cases had TB cured in time, 48 (46.60%) cases had therapy prolonged, and 2 (1.94%) cases died. Compared with non-ATLI patients, ATLI patients had a 9.25-fold (95%CI, 5.69–15.05) risk of unsuccessful anti-TB treatment outcomes and a 2.11-fold (95%CI,1.23–3.60) risk of prolonged intensive treatment phase. ATLI could considerably impact the outcomes of anti-TB treatment. Given the incidence of ATLI and the size of TB population in China, the negative impact is substantial. Therefore, more research and efforts are warranted in order to enhance the diagnosis and the prevention of ATLI.
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影响因子：
4.3
作者：
Gulbay, Banu Eris;Gurkan, Ozlem Ural;Acican, Turan
通讯作者：
Acican, Turan
影响因子：
4.2
作者：
Baghaei, Parvaneh;Tabarsi, Payam;Masjedi, Mohammadreza
通讯作者：
Masjedi, Mohammadreza
影响因子：
4.5
作者：
Kaona FA;Tuba M;Siziya S;Sikaona L
通讯作者：
Sikaona L
DOI：
10.1016/s0962-8479(96)90073-8
发表时间：
1996-02-01
期刊：
TUBERCLE AND LUNG DISEASE
影响因子：
--
作者：
Ormerod, LP;Horsfield, N
通讯作者：
Horsfield, N
影响因子：
13.5
作者：
Huang, YS;Chern, HD;Lee, SD
通讯作者：
Lee, SD