Israel H L, Gottlieb J E, Maddrey W C
Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia.
Chest. 1992 May;101(5):1298-301. doi: 10.1378/chest.101.5.1298.
The preventive use of isoniazid (INH) has been controversial since 1975, but official agencies continue to advocate the procedure. Cost-effectiveness and risk benefit studies of preventive INH use have come to conflicting conclusions. A review of eight such studies indicates an increasing tendency to minimize INH hepatotoxicity and to disregard the declining tuberculosis morbidity and mortality in countries in which INH prophylaxis has not been widely adopted. We report three cases of fatal INH-associated hepatitis that illustrate that this complication of preventive INH use remains a serious problem. Current recommendations that encourage wide use of preventive INH therapy are unwise because they inflict a risk of fatal hepatitis on compliant adults and older children who have little danger of tuberculosis while being difficult to deliver to the alcohol- and drug-addicted persons whose risk is high. Health departments and physicians should severely restrict preventive INH therapy.
自1975年以来，预防性使用异烟肼（INH）一直存在争议，但官方机构仍继续提倡这一做法。关于预防性使用INH的成本效益和风险效益研究得出了相互矛盾的结论。对八项此类研究的综述表明，越来越倾向于将INH肝毒性降至最低，并忽视在未广泛采用INH预防措施的国家中结核病发病率和死亡率的下降。我们报告了三例与INH相关的致命性肝炎病例，这些病例表明预防性使用INH的这种并发症仍然是一个严重问题。目前鼓励广泛使用预防性INH治疗的建议是不明智的，因为它们会给患结核病风险很小的依从性好的成年人和大龄儿童带来致命性肝炎的风险，同时又难以惠及酗酒和吸毒成瘾且风险较高的人群。卫生部门和医生应严格限制预防性INH治疗。
