Abbara Aula, Chitty Sarah, Roe Jennifer K, Ghani Rohma, Collin Simon M, Ritchie Andrew, Kon Onn Min, Dzvova John, Davidson Harriet, Edwards Thomas E, Hateley Charlotte, Routledge Matthew, Buckley Jim, Davidson Robert N, John Laurence
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
NHLI, Imperial College London, London, UK.
BMC Infect Dis. 2017 Mar 24;17(1):231. doi: 10.1186/s12879-017-2330-z.
We describe drug-induced liver injury (DILI) secondary to antituberculous treatment (ATT) in a large tuberculosis (TB) centre in London; we identify the proportion who had risk factors for DILI and the timing and outcome of DILI.
We identified consecutive patients who developed DILI whilst on treatment for active TB; patients with active TB without DILI were selected as controls. Comprehensive demographic and clinical data, management and outcome were recorded.
There were 105 (6.9%) cases of ATT-associated DILI amongst 1529 patients diagnosed with active TB between April 2010 and May 2014. Risk factors for DILI were: low patient weight, HIV-1 co-infection, higher baseline ALP, and alcohol intake. Only 25.7% of patients had British or American Thoracic Society defined criteria for liver test (LT) monitoring. Half (53%) of the cases occurred within 2 weeks of starting ATT and 87.6% occurred within 8 weeks. Five (4.8%) of seven deaths were attributable to DILI.
Only a quarter of patients who developed DILI had British or American Thoracic Society defined criteria for pre-emptive LT monitoring, suggesting that all patients on ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment.
我们描述了伦敦一家大型结核病中心抗结核治疗（ATT）继发的药物性肝损伤（DILI）；我们确定了有DILI危险因素的患者比例以及DILI的发生时间和结局。
我们确定了在接受活动性结核病治疗期间发生DILI的连续患者；选择无DILI的活动性结核病患者作为对照。记录全面的人口统计学和临床数据、管理情况及结局。
在2010年4月至2014年5月期间确诊的1529例活动性结核病患者中，有105例（6.9%）发生了与ATT相关的DILI。DILI的危险因素包括：患者体重低、HIV-1合并感染、基线碱性磷酸酶（ALP）较高以及饮酒。只有25.7%的患者符合英国或美国胸科学会定义的肝酶检测（LT）监测标准。半数（53%）病例在开始ATT后2周内发生，87.6%在8周内发生。7例死亡中有5例（4.8%）归因于DILI。
发生DILI的患者中只有四分之一符合英国或美国胸科学会定义的预防性LT监测标准，这表明所有接受ATT治疗的患者都应考虑进行普遍的肝脏监测，尤其是在治疗的前8周。
