Turner M O, Elwood R K
Division of Tuberculosis Control, British Columbia Centre for Disease Control, Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia.
Can J Infect Dis. 1999 Mar;10(2):167-9. doi: 10.1155/1999/342613.
Hepatotoxicity from antituberculous therapy is well described, but fortunately severe complications are rare. The optimal methods of monitoring for significant hepatotoxicity while on treatment are uncertain. Some authorities recommend measuring liver enzymes only if symptoms develop, whereas others recommend regular liver enzyme monitoring throughout the course of therapy. In British Columbia, from 1990 to 1997, 2624 active and approximately 8000 chemoprophylaxis cases have been treated, but only two severe complications directly related to antituberculous therapy have occurred. A 33-year-old male developed fulminant hepatic failure seven months after starting isoniazid chemoprophylaxis and required a liver transplant. The other patient died from hepatic failure that developed in the first month of triple-drug therapy for proven active pulmonary tuberculosis. The early and late onset of hepatic failure associated with antituberculous therapy in these cases underline the difficulties in identifying a monitoring protocol that will totally negate the risk of severe complications.
抗结核治疗引起的肝毒性已有充分描述，但幸运的是严重并发症很少见。治疗期间监测显著肝毒性的最佳方法尚不确定。一些权威机构建议仅在出现症状时才检测肝酶，而另一些机构则建议在整个治疗过程中定期监测肝酶。在不列颠哥伦比亚省，1990年至1997年期间，共治疗了2624例活动性病例和约8000例化学预防病例，但仅发生了两例与抗结核治疗直接相关的严重并发症。一名33岁男性在开始异烟肼化学预防七个月后发生暴发性肝衰竭，需要进行肝移植。另一名患者在确诊为活动性肺结核的三联药物治疗的第一个月死于肝衰竭。这些病例中与抗结核治疗相关的肝衰竭的早期和晚期发生凸显了确定一个能完全消除严重并发症风险的监测方案的困难。
