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目的探讨结核治疗期间患者的肝损伤表现与相关影响因素,为抗结核药物造成的肝损伤的预防、治疗和护理工作提供依据。方法采用前瞻性调查的方式,选取2012年1月—2015年6月间诊断的新发肺结核病例305例,进行为期6个月的随访,剔除失访病例,实际纳入病例288例,随访开始前进行问卷及相关实验室检查确定基线数据,随访结束后,采集患者抗结核药物性肝损伤(anti-tuberculosis drug induced liver injury,ATLI)发病情况,症状分布,分析影响ATLI发生的相关因素,相关危险因素分析采用χ~2检验,以P<0.05为差异有统计学意义。结果发生ATLI患者101例(35.07%);单症状分布前三位分别是胃肠反应(56.78%)、皮肤过敏反应(21.19%)、乏力(14.41%);多发症状患者中,二联症状发生率最高的症状组合为胃肠反应与乏力(41.56%);三联症状发生率最高的症状组合为胃肠反应、皮肤过敏及乏力并存(45.65%)。ATLI相关危险因素分析显示,年龄、性别、饮酒与规律用药,分组差异均有统计学意义(P<0.05)。结论 ATLI在结核药物治疗患者中的发病率较高,症状以胃肠道反应、皮肤过敏反应和乏力为主;年龄、性别、饮酒以及规范用药,均对ATLI的发病具有影响。
Objective To explore the manifestation and related factors of liver injury in patients during tuberculosis treatment and provide the basis for the prevention, treatment and nursing of liver injury caused by antituberculosis drugs. Methods A prospective investigation was conducted to select 305 new cases of pulmonary tuberculosis diagnosed between January 2012 and June 2015 for follow-up of 6 months. The number of cases without follow-up was excluded and 288 cases were actually included. Before the start of follow-up, The questionnaires and related laboratory tests were performed to determine the baseline data. At the end of follow-up, the incidence of ATLI and the distribution of symptoms were collected, and the related factors influencing the occurrence of ATLI, the related risk Factor analysis using χ ~ 2 test to P <0.05 was considered statistically significant. Results There were 101 cases (35.07%) of patients with ATLI. The first three symptoms of single symptom were gastrointestinal reaction (56.78%), skin allergic reaction (21.19%) and weakness (14.41%). The combination of symptoms with the highest rate was gastrointestinal reaction and fatigue (41.56%). The symptoms with the highest incidence of triple symptoms were gastrointestinal reaction, skin allergy and fatigue (45.65%). ATLI-related risk factors analysis showed that age, gender, alcohol consumption and regular medication, group differences were statistically significant (P <0.05). Conclusion The incidence of ATLI in tuberculosis patients is high. The symptoms are mainly gastrointestinal tract reaction, skin allergy and fatigue. Age, sex, alcohol consumption and normative medication have an impact on the incidence of ATLI.