目的了解维吾尔族肺结核患者化疗中肝损害发生情况,探讨导致肝损害可能的危险因素,为今后结核病的治疗与控制提供一定的依据。方法采用巢式病例对照研究的方法,对新疆南疆某地区1135例维吾尔族患者进行随访及资料收集,对可能诱导抗结核药物性肝损害的相关因素进行统计分析和推论。结果抗结核药物所致肝损害(anti—tuberculosisdruginducedliverinjury,ATLI)的总发生率为3.08%。经单因素检验,既往有肝病史差异有统计学意义(x^2=21.273,P〈0.001);多因素非条件Logistic回归分析显示治疗前血清转氨酶升高(OR=2.978,95%CI:1.168-7.593)和既往有肝炎病史(OR=21.852,95%CI:5.410~88.196)与ATLI的发生呈正相关。结论与发生ATLI有关的危险因素是治疗前血清转氨酶升高和既往有肝炎病史。提示肺结核化疗强化期间,应加强检测肝功能,密切观察具有可能危险因素的患者,用药前可采取适当措施以提高治愈率。
Objective To investigate the incidence of liver injury in Uygur patients with pulmonary tuberculosis during anti-tuberculosis chemotherapy and explore the causes of possible risk factors of liver injury, for a basis for treatment and control of tuberculosis. Methods A nested case-control study of 1 135 cases of Uygur patients were followed up and data were collected. Potential factors of ATLI were analyzed. Results Incidence of ATLI was 3.08%. The single test showed a history of liver disease was statistically significant ( x^2 = 21. 273, P 〈 0. 001 ). The results of multivariate Logistic regression analysis indicated that ATLI was associated with a elevated serum transaminases before treatment ( OR = 2. 978, 95% CI:1. 168-7.593) and previous history of hepatitis (OR =21.852,95% CI:5.410-88. 196). Conclusions The treatment of TB patients have a elevated serum transaminases before treatment and previous history of hepatitis may be the risk factor of ATLI. In the tuberculosis patients receiving anti-TB drugs, the monitoring of liver function should be stren- thened. Patients with possible risk factors should be observed closely so that appropriate measures can be taken to improve the treatment effect.