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目的 探讨抗结核药物应用过程中产生的肝损害问题。方法 对1995年1月至2002年12月住院的1 464例肺结核病患者中应用抗结核药物后出现肝损害的172例患者进行回顾性分析。结果 抗结核药物肝损害的高发年龄为20~60岁,占70 .3%,消化道症状出现和肝功能改变发生于用药后8周内强化治疗期的占73. 8%,轻者加保肝药治疗可不需停用抗结核药物,重者须停药并着重保肝治疗。157例(91 .3% )恢复正常, 13例(7 .6% )好转, 2例恶化出院, 41例( 23. 8% )需减量或停药,对化疗效果产生影响。结论 应用抗结核药物易发生肝损害,体重<50kg的老年男性、既往已有肝损害或嗜肝病毒感染、饮酒、合并肺外疾病、异烟肼、利福平、吡嗪酰胺三药联用等为易感因素。
Objective To investigate the liver damage caused by the application of anti-TB drugs. Methods A retrospective analysis was performed on 172 patients with liver damage after antituberculosis drugs in 1 464 pulmonary tuberculosis patients hospitalized from January 1995 to December 2002. Results The incidence of anti-TB drug-induced liver damage was 20-60 years old, accounting for 70.3%. The occurrence of gastrointestinal symptoms and liver function changes occurred in 73.8% of patients undergoing intensive treatment within 8 weeks after treatment. Hepatic drug treatment without stopping the anti-TB drugs, severe cases should be discontinued and focus on liver protection. 157 cases (91.3%) returned to normal, 13 cases (7.6%) improved, 2 patients were exacerbated and 41 patients (23.8%) required dose reduction or withdrawal, which had an impact on the effect of chemotherapy. Conclusions The elderly men who are prone to develop liver damage by anti-TB drugs and whose body weight is less than 50kg have previous liver damage or hepadnavirus infection, alcohol consumption, combined with extrapulmonary disease, isoniazid, rifampicin and pyrazinamide As a susceptible factor.