Clinical Features and Prognostic Factors of 310 Patients with Antituberculosis Drug-induced Liver Injury

Xuejiao WU; Jiangli PENG; Hao FAN; Lu WANG; Jie CHEN; Hui LIU

doi:10.12259/j.issn.2095-610X.S20240324

Volume 45 Issue 3

Mar. 2024

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Xuejiao WU, Jiangli PENG, Hao FAN, Lu WANG, Jie CHEN, Hui LIU. Clinical Features and Prognostic Factors of 310 Patients with Antituberculosis Drug-induced Liver Injury[J]. Journal of Kunming Medical University, 2024, 45(3): 157-165. doi: 10.12259/j.issn.2095-610X.S20240324

Citation:

Xuejiao WU, Jiangli PENG, Hao FAN, Lu WANG, Jie CHEN, Hui LIU. Clinical Features and Prognostic Factors of 310 Patients with Antituberculosis Drug-induced Liver Injury[J]. Journal of Kunming Medical University, 2024, 45(3): 157-165. doi: 10.12259/j.issn.2095-610X.S20240324

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Clinical Features and Prognostic Factors of 310 Patients with Antituberculosis Drug-induced Liver Injury

doi: 10.12259/j.issn.2095-610X.S20240324

Xuejiao WU¹,
Jiangli PENG^{2
,
,},
Hao FAN¹,
Lu WANG^{2
,
,},
Jie CHEN²,
Hui LIU²

1.
College of Pharmacy，Dali University，Dali Yunnan 671000
2.
Dept.of Pharmacy，Kunming 3rd People's Hospital，Kunming Yunnan 650041，China

Received Date: 2023-11-06
Publish Date: 2024-03-25

Abstract

Abstract

Objective To analyze the clinical characteristics of 310 patients with anti-tuberculosis drug-induced liver injury （ATB-DILI）, to explore prognostic influencing factors, and to provide reference for its prevention and treatment. Methods Primary tuberculosis patients hospitalized in the Department of Tuberculosis of the Third People's Hospital of Kunming from November 2020 to November 2022 who met the diagnosis of ATB-DILI were enrolled. Statistics by gender, age, history, type of tuberculosis, co-morbidities, frequency of anti-tuberculosis regimens leading to liver injury, use of hepatoprotective drugs, and management and regression were performed to analyze the clinical characteristics of the patients and the factors influencing their prognosis. Results 310 patients were included, male, 148 （47.74%） and female, 162 （52.26%）. The mean age was 44.33±17.47 years. Thirty-four patients had a history of allergy. The combination of isoniazid, rifampicin, pyrazinamide, and ethambutol （244 patients, 78.71%） was the anti-tuberculosis regimen that resulted in the highest number of cases of hepatic injury. The median time between initiation of the tuberculosis regimen and the development of hepatic injury in patients with ATB-DILI was 30 d, and the mean duration of hospitalization was 16.39±7.01 d. The most used hepatoprotective drug was reduced glutathione （154 patients, 49.68%）, and most patients used a combination of 2 hepatoprotective drugs （128 patients, 41.29%）. Liver injury improved in 257 cases （82.90%） and failed in 53 cases （17.10%）. The differences in alcohol consumption, severity, clinical staging, TT, ALP, TBIL, DBIL, IBIL, and GGT were statistically significant compared to those who did not recover （P < 0.05）, and severity and high ALP were independent risk factors for poor prognosis. Conclusions Patients should be carefully asked if they have a history of basic liver disease and alcoholism before using anti-tuberculosis drugs. In the course of anti-tuberculosis treatment, the combined use of anti-tuberculosis drugs is more serious than the use of single drugs to cause liver damage. Drugs that may cause liver damage should be used with caution and improved anti-tuberculosis programs should be explored. At the same time, liver function should be monitored regularly during anti-tuberculosis treatment, especially 30 days after medication, in order to reduce the occurrence of adverse reactions.
- Anti-tuberculosis drug-induced liver injury,
- ATB-DILI,
- Clinical features,
- Influ-encing factors

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References(22)

References

[1]	徐彩红,赵雁林. 从《2020年全球结核病报告》看我国结核病防治工作[J]. 中华传染病杂志,2021,39(7):392-397. doi: 10.3760/cma.j.cn311365-20210406-00117
[2]	Xu N,Yang J X,Yang J. Incidence and associated risk factors of antituberculosis drug-induced hepatotoxicity among hospitalised patients in Wuhan,China[J]. Eur J Hosp Pharm,2022,29(4):217-221. doi: 10.1136/ejhpharm-2020-002433
[3]	Chalasani N P,Maddur H,Russo M W,et al. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol,2021,116(5):878-898. doi: 10.14309/ajg.0000000000001259
[4]	Song J H,Yoon S Y,Park T Y,et al. The clinical impact of drug-induced hepatotoxicity on anti-tuberculosis therapy: a case control study[J]. Respir Res.,2019,20(1):283-283. doi: 10.1186/s12931-019-1256-y
[5]	抗结核药物性肝损伤诊治指南（2019年版）[J]. 中华结核和呼吸杂志, 2019, 42（5）: 343-356.
[6]	刘娟,黄锐,张晶,等. 222例抗结核药致药物性肝损伤患者临床特征及预后分析[J]. 中国药业,2022,31(23):57-61. doi: 10.3969/j.issn.1006-4931.2022.23.013
[7]	Shen T,Liu Y,Shang J,et al. Incidence and etiology of drug-induced liver injury in Mainland of China[J]. Gastroenterology,2019,156(8):2230-2241. doi: 10.1053/j.gastro.2019.02.002
[8]	刘遥,王宪波. 药物性肝损伤常见药物发病机制的研究进展[J]. 中西医结合肝病杂志,2020,30(1):20-23.
[9]	金小琳,马龙,殷水泽,等. 乙胺丁醇所致药物性肝损伤的研究进展[J]. 中华传染病杂志,2022,40(12):756-759. doi: 10.3760/cma.j.cn311365-20220228-00069
[10]	申美荣,黄娟君,蔡婷婷. 护肝药对抗结核所致药物性肝损伤及预后影响的临床观察[J]. 当代医学,2021,27(6):185-186. doi: 10.3969/j.issn.1009-4393.2021.06.077
[11]	辛宝双,王雪梅,徐齐峰. 还原型谷胱甘肽、异甘草酸镁对抗结核所致药物性肝损伤的影响[J]. 黑龙江医药,2022,35(4):840-842.
[12]	肖敏敏,王玉梅,姚碧波,等. 还原型谷胱甘肽联合双环醇对抗结核药物导致肝损伤患者肝功能和氧化应激反应的影响[J]. 中国医院用药评价与分析,2023,23(3):287-289.
[13]	于雪,丁宁. 探讨双环醇联合还原型谷胱甘肽治疗抗结核药物性肝炎患者的临床疗效[J]. 中国医药指南,2020,18(18):104-105.
[14]	周晓颖,王琳. 双环醇联合还原型谷胱甘肽治疗抗结核药物性肝炎的临床分析[J]. 中国医药指南,2020,18(5):76-77.
[15]	Wang Y,Lai R,Zong P,et al. Bicyclol for the treatment of drug-induced liver injury: A propensity score matching analysis using a nationwide inpatient database[J]. Journal of International Medical Research,2021,49(4):489-499.
[16]	王瑜,仇丽霞,范作鹏,等. 不同类型的急性药物性肝损伤患者临床特征比较[J]. 临床肝胆病杂志,2021,37(3):632-635.
[17]	Siddique A,Kowdley KV. Approach to a patient with elevated serum alkaline phosphatase[J]. Clin Liver Dis.,2012,16(2):199-229. doi: 10.1016/j.cld.2012.03.012
[18]	Yew W W,Chang K C,Chan D P,et al. Oxidative stress and first-line antituberculosis drug-induced hepatotoxicity[J]. Antimicrobial Agents and Chemotherapy,2018,62(8):1-17.
[19]	刘茹佳,辛小娟. 药物性肝损伤发生机制,危险因素,监测以及再用药的研究进展[J]. 临床肝胆病杂志,2023,39(4):968-973.
[20]	刘萌萌. APTT、PT、FIB、TT四项标志物诊断病毒性肝炎的价值[J]. 中国疗养医学,2019,28(7):778-780.
[21]	李应懿,陈挥昂,谢青,等. 药物性肝损伤的生物标志物研究进展[J]. 肝脏,2022,27(12):1258-1263. doi: 10.3969/j.issn.1008-1704.2022.12.003
[22]	刘丽娜,赵建学,陆玮婷,等. 138例药物性肝损伤患者影响预后的因素分析[J]. 实用肝脏病杂志,2015,18(2):160-163. doi: 10.3969/j.issn.1672-5069.2015.02.013

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