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目的:分析抗结核组合药引起药物性肝损害的临床表现、实验室特点、结局,并确定其90天死亡率的预测因子。方法:对2010年~2012年期间入住我院的抗结核组合药引起药物性肝损害病例共269例进行回顾性临床研究。结果:在269例患者中,191例(71%)出现黄疸、69例(25.7%)发生急性肝衰竭。平均年龄和治疗时间分别为41.3个月和1.9个月,男性占55.7%。药物性肝损害在整个疗程中均有发生,其中3/4病例发生于头2个月,艾滋病病毒感染21例(7.8%),90天死亡率为22.7%,其中黄疸(191例)90天死亡率为30%,肝性脑病(69例)90天死亡率为69.6%,腹水组(69例)90天死亡率为50.7%(P((0.001)。年龄、性别、转氨酶水平、HIV或乙肝病毒携带状态均不影响生存率。抗结核治疗时程、肝性脑病、腹水、胆红素、血清白蛋白、国际标准化比值(INR)、血清肌酐、白细胞计数均与死亡率相关(P((0.001)。以肝性脑病、白蛋白、胆红素、INR、肌酐为变量的死亡率多元逻辑回归模型的C统计量为97%。结论:抗结核药物性肝损害可在整个疗程的任何时间发生,其中有1/4的患者进展至急性肝衰竭,总的死亡率是22.7%,若合并黄疸、腹水或肝性脑病则死亡率明显升高。患者的胆红素水平、INR值、肝性脑病、血清肌酐和白蛋白水平为抗结核药物性肝损害死亡风险预测因子。
OBJECTIVE: To analyze the clinical manifestations, laboratory characteristics, outcomes of anti-TB drugs that cause drug-induced liver damage and to determine their 90-day mortality predictors. Methods: A total of 269 cases of drug-induced liver damage caused by antituberculosis drugs admitted to our hospital from 2010 to 2012 were retrospectively studied. Results: Of the 269 patients, 191 (71%) developed jaundice and 69 (25.7%) developed acute liver failure. The mean age and treatment time were 41.3 months and 1.9 months respectively, with men accounting for 55.7%. Drug-induced liver damage occurred throughout the course of treatment, with 3/4 cases occurring in the first 2 months, 21 cases (7.8%) of HIV infections, and 90 days mortality rate of 22.7%, with jaundice (191 cases) for 90 days The 90-day mortality rate was 69.6% in hepatic encephalopathy (69 cases) and 50.7% (P <0.001) in 90 cases of ascites group (69 cases). The age, gender, aminotransferase level, Hepatic encephalopathy, ascites, bilirubin, serum albumin, international normalized ratio (INR), serum creatinine and white blood cell count were all associated with mortality (P (P (0.001) .The C statistic of multivariate logistic regression model with mortality of hepatic encephalopathy, albumin, bilirubin, INR, creatinine was 97% .Conclusion: The anti-TB drug- Time, of which 1 in 4 patients progressed to acute liver failure, the overall mortality rate was 22.7%, with jaundice, ascites or hepatic encephalopathy, the mortality was significantly increased.The patient’s bilirubin level, INR value, Hepatic encephalopathy, serum creatinine and albumin levels predict the risk of death from anti-TB drug-induced liver injury .