A Comparison between Two Strategies for Monitoring Hepatic Function during Antituberculous Therapy
A Comparison between Two Strategies for Monitoring Hepatic Function during Antituberculous Therapy
复制标题
DOI：
10.1164/rccm.201105-0850oc
复制
发表时间：
2012-03-15
影响因子：
24.7
通讯作者：
Kon, Onn Min
中科院分区：
文献类型：
--
作者：
Singanayagam, Aran;Sridhar, Saranya;Kon, Onn Min
理论基础：在抗结核治疗中监测肝功能的最佳策略尚不清楚。目的：评估美国胸科学会危险因素方法在预测药物性肝损伤方面的价值，并与两周内所有患者的统一肝功能检测政策进行比较。方法：我们对在三级中心接受活动性结核病治疗的成年患者进行了一项观察性研究。所有患者在基线和治疗开始后2周进行丙氨酸转移酶检测。评估方法和主要结果：288例患者中，21例(7.3%)发展为药物性肝损伤(在2wk时早期为57.1%，2周后为42.9%)。早期药物性肝损伤组的HIV感染率高于非药物性肝损伤组和晚期药物性肝损伤组(33%比7.1%比0%；P=0.004)。美国胸科学会算法预测早期药物性肝损伤的灵敏度和特异度分别为66.7%和65.6%，晚期药物性肝损伤的灵敏度和特异度分别为22.2%和63.7%。统一监测策略对预测晚期药物性肝损伤的敏感性较差，但特异度较高(分别为22.2%和82.1%)。结论：在我国城市少数民族人群中，危险因素方法对预测药物性肝损伤既不敏感，也不特异。统一的2周肝功能检测策略有助于及时识别早期药物性肝损伤的亚组，并可能为排除晚期药物性肝损伤提供更好的特异性。
Rationale: The optimum strategy for monitoring liver function during antituberculous therapy is unclear.Objectives: To assess the value of the American Thoracic Society risk-factor approach for predicting drug-induced liver injury and to compare with a uniform policy of liver function testing in all patients at 2 weeks.Methods: We conducted an observational study of adult patients undergoing therapy for active tuberculosis at a tertiary center. All patients had alanine transferase measurement at baseline and 2 weeks following commencement of therapy. Sensitivity, specificity, and positive and negative predictive values were used to assess strategies.Measurements and Main Results: There were 288 patients included, and 21 (7.3%) developed drug-induced liver injury (57.1% "early" at 2 wk and 42.9% "late," after 2 wk). There were increased rates of individuals with HIV infection in the early drug-induced liver injury group compared with no drug-induced liver injury and late drug-induced liver injury groups (33% vs. 7.1% vs. 0%; P = 0.004). The American Thoracic Society algorithm had a sensitivity and specificity of 66.7 and 65.6%, respectively, for prediction of early and 22.2% and 63.7% for late drug-induced liver injury. The uniform monitoring policy had poor sensitivity but better specificity (22.2 and 82.1%) for prediction of late drug-induced liver injury.Conclusions: In our urban, ethnically diverse population, a risk-factor approach is neither sensitive nor specific for prediction of drug-induced liver injury. A uniform policy of liver function testing at 2 weeks is useful for prompt identification of a subgroup who develop early drug-induced liver injury and may offer better specificity in ruling out late drug-induced liver injury.