Departments of GastroenterologyAll India Institute of Medical Sciences, New Delhi, India.
Hepatology. 2010 May;51(5):1665-74. doi: 10.1002/hep.23534.
Antituberculosis therapy (ATT)-associated acute liver failure (ATT-ALF) is the commonest drug-induced ALF in South Asia. Prospective studies on ATT-ALF are lacking. The current study prospectively evaluated the magnitude, clinical course, outcome, and prognostic factors in ATT-ALF. From January 1986 to January 2009, 1223 consecutive ALF patients were evaluated: ATT alone was the cause in 70 (5.7%) patients. Another 15 (1.2%) had ATT and simultaneous hepatitis virus infection. In 44 (62.8%) patients, ATT was prescribed empirically without definitive evidence of tuberculosis. ATT-ALF patients were younger (32.87 [+/-15.8] years), and 49 (70%) of them were women. Most had hyperacute presentation; the median icterus encephalopathy interval was 4.5 (0-30) days. The median duration of ATT before ALF was 30 (7-350) days. At presentation, advanced encephalopathy and cerebral edema were present in 51 (76%) and 29 (41.4%) patients, respectively. Gastrointestinal bleed, seizures, infection, and acute renal failure were documented in seven (10%), five (7.1%), 26 (37.1%), and seven (10%) patients, respectively. Compared with hepatitis E virus (HEV) and non-A non-E-induced ALF, ATT-ALF patients had nearly similar presentations except for older age and less elevation of liver enzymes. The mortality rate among patients with ATT-ALF was high (67.1%, n = 47), and only 23 (32.9%) patients recovered with medical treatment. In multivariate analysis, three factors independently predicted mortality: serum bilirubin (>or=10.8 mg/dL), prothrombin time (PT) prolongation (>or=26 seconds), and grade III/IV encephalopathy at presentation.
ATT-ALF constituted 5.7% of ALF at our center and had a high mortality rate. Because the mortality rate is so high, determining which factors are predictors is less important. A high proportion of patients had consumed ATT empirically, which could have been prevented.
抗结核治疗（ATT）相关急性肝衰竭（ATT-ALF）是南亚最常见的药物诱导性 ALF。缺乏对 ATT-ALF 的前瞻性研究。本研究前瞻性评估了 ATT-ALF 的发病程度、临床病程、预后和预后因素。
1986 年 1 月至 2009 年 1 月，连续评估了 1223 例 ALF 患者：单独使用 ATT 是原因的有 70 例（5.7%）。另外 15 例（1.2%）同时有 ATT 和同时感染肝炎病毒。在 44 例（62.8%）患者中，ATT 是经验性使用的，没有结核病的明确证据。
ATT-ALF 患者更年轻（32.87[+/-15.8]岁），其中 49 例（70%）为女性。大多数表现为超急性发作；中位黄疸性肝性脑病间隔为 4.5（0-30）天。在发生 ALF 之前，ATT 的中位时间为 30（7-350）天。就诊时，51 例（76%）和 29 例（41.4%）患者分别存在严重的肝性脑病和脑水肿。7 例（10%）、5 例（7.1%）、26 例（37.1%）和 7 例（10%）患者分别有胃肠道出血、癫痫发作、感染和急性肾衰竭。与戊型肝炎病毒（HEV）和非甲非乙型肝炎引起的 ALF 相比，ATT-ALF 患者的临床表现相似，除了年龄较大和肝酶升高不明显。ATT-ALF 患者的死亡率很高（67.1%，n=47），只有 23 例（32.9%）患者经药物治疗恢复。多因素分析显示，3 个因素独立预测死亡率：血清胆红素（>或=10.8mg/dL）、凝血酶原时间（PT）延长（>或=26 秒）和就诊时 III/IV 级肝性脑病。
在我们中心，ATT-ALF 占 ALF 的 5.7%，死亡率很高。由于死亡率如此之高，确定哪些因素是预测因素就不那么重要了。很大比例的患者是经验性使用 ATT 的，这是可以预防的。
