Gray E L, Goldberg H F
Department of Respiratory Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2016 Mar;46(3):281-7. doi: 10.1111/imj.12979.
One of the cornerstones of Australia's public health programmes to eliminate tuberculosis (TB) is the identification and treatment of latent tuberculosis infection (LTBI).
The main aim of this study is to determine the demographics, compliance, completion rates and adverse events of patients on preventive therapy (PT) for LTBI at our institution. The secondary aim is to determine the rates of isoniazid (INH) hepatotoxicity and identify any contributory factors.
The method used was an audit using medical records of 100 consecutive patients (2010-2014) treated with PT for LTBI.
Seventy-two patients with confirmed LTBI started 9 months of INH and 22 started 4 months of rifampicin (RIF). The median age was 30 years. Half the patients were born in high TB-prevalence countries. Fifty-six per cent were contacts of index cases with confirmed TB, and 26% were pre-immunosuppression. Seventy-seven per cent completed PT with adequate compliance. Thirty-three per cent on INH and 23% on RIF experienced some liver function test (LFT) abnormality while on treatment. INH was ceased in 3% due to asymptomatic hepatic dysfunction (transaminases >5x upper limit of normal). No patients had permanent liver damage. Significant risk factors for liver dysfunction during PT were risk factors for liver disease (χ(3)(2) = 8.7; P = 0.03) or abnormal pre-therapy LFT (χ(3)(2)= 22.4; P < 0.001). No patients developed active TB.
The completion rate of 77% and rate of INH-induced hepatic dysfunction of 3% is comparable with the literature. We found no age association with the risk of INH-induced hepatic dysfunction; however, there was a significant and linear association with the degree of liver function abnormality during INH therapy and the presence of abnormal baseline LFT. Routine LFT monitoring allowed early cessation of INH in those with significant but asymptomatic hepatitis who did not meet criteria for ATS/CDC LFT monitoring.
澳大利亚消除结核病（TB）公共卫生项目的基石之一是识别和治疗潜伏性结核感染（LTBI）。
本研究的主要目的是确定我院接受潜伏性结核感染预防性治疗（PT）患者的人口统计学特征、依从性、完成率和不良事件。次要目的是确定异烟肼（INH）肝毒性发生率并识别任何促成因素。
采用的方法是对100例连续接受潜伏性结核感染预防性治疗（2010 - 2014年）患者的病历进行审核。
72例确诊为潜伏性结核感染的患者开始接受9个月的异烟肼治疗，22例开始接受4个月的利福平（RIF）治疗。中位年龄为30岁。一半患者出生于结核病高流行国家。56%是确诊结核病索引病例的接触者，26%处于免疫抑制前期。77%的患者依从性良好并完成了预防性治疗。接受异烟肼治疗的患者中有33%、接受利福平治疗的患者中有23%在治疗期间出现了一些肝功能检查（LFT）异常。3%的患者因无症状肝功能障碍（转氨酶>正常上限5倍）停用异烟肼。没有患者出现永久性肝损伤。预防性治疗期间肝功能障碍的显著危险因素是肝脏疾病的危险因素（χ(3)(2) = 8.7；P = 0.03）或治疗前肝功能检查异常（χ(3)(2)= 22.4；P < 0.001）。没有患者发生活动性结核病。
77%的完成率和3%的异烟肼所致肝功能障碍发生率与文献报道相当。我们发现年龄与异烟肼所致肝功能障碍风险无关；然而，异烟肼治疗期间肝功能异常程度与基线肝功能检查异常之间存在显著的线性关联。常规肝功能检查监测使那些有显著但无症状肝炎且不符合美国胸科学会/美国疾病控制与预防中心肝功能检查监测标准的患者能够早期停用异烟肼。
