Centre Hépato-BiliaireAP-HP Hôpital Paul Brousse, Villejuif, France.
Liver Transpl. 2010 Oct;16(10):1136-46. doi: 10.1002/lt.22125.
The standard antitubercular treatment (ATT), which consists of isoniazid (INH), rifampicin (RIF), ethambutol, and pyrazinamide (PZA), is the best available treatment for tuberculosis (TB). However, the hepatotoxicity of INH and PZA can be severe, and even after drug withdrawal, patients may require liver transplantation (LT). In these cases, the strategy for the treatment of TB is poorly defined. Between 1986 and 2008, 14 patients presented at our department with severe hepatitis secondary to INH and PZA treatment. Four of these patients were immunosuppressed: 2 after renal transplantation and 2 because of human immunodeficiency virus infection. In seven of the 14 patients an alternative ATT was begun on admission, which was well tolerated. Hepatitis improved spontaneously in 5 patients, and alternative ATT was continued for 9.3 ± 4.2 months; 1 patient deteriorated and underwent LT, and 1 patient died. ATT was stopped definitively in 2 patients. Six patients required urgent LT, and alternative ATT was started after transplantation and was successful. Five patients receiving RIF had an episode of acute rejection. In conclusion, hepatitis secondary to ATT can be successfully treated with alternative anti-TB regimens. The use of RIF in LT patients may lead to acute rejection. RIF should therefore be avoided in these patients.
标准抗结核治疗（ATT）包括异烟肼（INH）、利福平（RIF）、乙胺丁醇和吡嗪酰胺（PZA），是治疗结核病（TB）的最佳方法。然而，INH 和 PZA 的肝毒性可能很严重，即使停药后，患者仍可能需要进行肝移植（LT）。在这些情况下，TB 的治疗策略尚未明确。1986 年至 2008 年间，我院共收治 14 例因 INH 和 PZA 治疗引起严重肝炎的患者。其中 4 例患者存在免疫抑制：2 例因肾移植后，2 例因人类免疫缺陷病毒感染。这 14 例患者中有 7 例在入院时开始采用替代 ATT，耐受性良好。5 例患者的肝炎自发改善，替代 ATT 持续使用 9.3±4.2 个月；1 例患者病情恶化并进行了 LT，1 例患者死亡。2 例患者永久停止 ATT。6 例患者需要紧急 LT，移植后开始替代 ATT，获得成功。5 例接受 RIF 的患者发生急性排斥反应。总之，ATT 引起的肝炎可以用替代抗结核方案成功治疗。RIF 在 LT 患者中的使用可能导致急性排斥反应。因此，应避免在这些患者中使用 RIF。
