| 摘要: |
| 目的:了解抗结核药物致儿童肝损害的发生情况以及相关影响因素,为从事儿童传染病诊疗活动的医务人员制定抗结
核方案提供参考。方法:回顾性分析2017-2021 年在南宁市第四人民医院住院,诊断为肺结核或肺外结核,接受抗结核药物治
疗的0~14 岁患儿227 例,对发生药物性肝损害的情况以及相关因素进行统计分析。结果:227 例结核病患儿抗结核治疗过程
中,发生药物性肝损害56 例(24. 7%)。其中婴儿(≤1 岁)13 例,发生肝损害8 例(61. 5%);发生药物性肝损害时间常见于用药
后1 周内(25 例,44. 6%),53 例(94. 4%)发生在用药后2 个月内;静脉用药、联合使用多种抗结核药物以及艾滋病合并结核病
的儿童发生药物性肝损害的概率较大。儿童结核病引起药物性肝损害的危险因素与性别无关,与年龄、给药途径、联合用药、用
药时间、合并艾滋病等因素有关。儿童结核病引起肝损害主要临床表现为无症状肝酶升高(64. 3%)及有明显纳差、恶心、呕吐、
腹痛、皮疹等临床症状(35. 7%)。结论:结核病婴儿(≤1 岁)在使用抗结核药物时发生药物性肝损害概率较大。肝损害发生时
间常在用药后1 周内,大部分肝损害发生在用药后2 个月内,且多数肝损害表现为无症状肝酶升高,建议监测肝功能时间为用
药后第1、2 周,后每2 周1 次直到2 个月,2 个月后每月1 次至疗程结束。 |
| 关键词: 抗结核药物 肝损害 儿童 影响因素 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2024.01.007 |
|
| 基金项目:广西壮族自治区卫生健康委员会自筹课题,编号Z-A20221208。 |
|
| Clinical Analysis of Liver Injury in 56 Children Induced by Anti-Tuberculosis Drugs |
| Qin Simei, Mo Shaungyan, Ma Xueqing, Ban Fengliu |
| ((The Fourth People’s Hospital of Nanning, Guangxi AIDS Clinical
Treatment Center (Nanning), Nanning 530023, China)) |
| Abstract: |
| Objective: To investigate the incidence of liver injury induced by anti-tuberculosis drugs in children and related influencing
factors, so as to provide reference for medical staff engaged in the diagnosis and treatment of children infectious diseases to develop antituberculosis
regimens. Methods: Retrospective analysis was performed on 227 cases of children from 0 to 14 years diagnosed with
pulmonary or extrapulmonary tuberculosis and received anti-tuberculosis drug therapy in the Fourth People’s Hospital of Nanning from
2017 to 2021. Occurrences of drug-induced liver injury and related factors were subjected for statistical analysis. Results: Among the
227 children with tuberculosis undergoing anti-tuberculosis therapy, 56 cases ( 24. 7%) experienced drug-induced liver injury.
Specifically, 13 cases were infants (⩽1 year) and liver injury occurred in 8 cases (61. 5%). The occurrence of drug-induced liver
injury was commonly within 1 week after drug administration (25 cases, 44. 6%); 53 cases (94. 6%) of adverse drug reactions occurred
within 2 months after drug administration. Intravenous drug administration, combined use of multiple anti-tuberculosis drugs, and
tuberculosis children with concurrent HIV infection had a higher probability of drug-induced liver injury. The risk factors for children
with tuberculosis-related drug-induced liver injury were found to be associated with age, administration route, drug combination,
duration of treatment, and concurrent HIV infection, while gender showed no significant correlation. The main clinical manifestations of
liver injury induced by tuberculosis in children were asymptomatic elevation of liver enzymes (64. 3%) and obvious clinical symptoms
(35. 7%) such as poor appetite, nausea, vomiting, abdominal pain, and rash. Conclusion: Infants (⩽1 year) with tuberculosis have
a higher probability of drug-induced liver injury during anti-tuberculosis therapy. Liver injury tends to occur within the first week of
administration, the majority of cases manifesting as asymptomatic elevation of liver enzymes within 2 months after administration. It is
recommended to monitor liver function in the first and second weeks after initiating treatment, every 2 weeks until 2 months, and then
monthly until completion of the course. |
| Key words: [Keywords]anti-tuberculosis drugs liver injury children influencing factors |
