Chang Lih-Yu, Lee Chih-Hsin, Chang Chia-Hao, Lee Ming-Chia, Lee Meng-Rui, Wang Jann-Yuan, Lee Li-Na
Department of Internal Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
Division of Pulmonary Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan.
BMC Infect Dis. 2018 Feb 1;18(1):64. doi: 10.1186/s12879-018-2966-3.
Tuberculosis (TB) remains one of the major infectious diseases worldwide. Adverse reactions are common during TB treatment. Few reports, however, are available on treatment-related acute biliary events (ABEs), such as cholelithiasis, biliary obstruction, acute cholecystitis, and cholangitis.
We first report four pulmonary TB patients who developed ABEs during anti-TB treatment. Abdominal sonography revealed multiple gall stones with dilated intrahepatic ducts in three patients and cholecystitis in one patient. To investigate the incidence of and risk factors for ABEs during anti-TB treatment, we subsequently conducted a nationwide cohort study using the National Health Insurance Research Database of Taiwan.
A total of 159,566 pulmonary TB patients were identified from the database between 1996 and 2010, and among them, 195 (0.12%) developed ABEs within 180 days after beginning anti-TB treatment. Logistic regression analysis revealed that the risk factors associated with ABEs are older age (relative risk [RR]: 1.32 [1.21-1.44] per 10-year increment) and diabetes mellitus (RR: 1.59 [1.19-2.13]).
Although infrequently encountered, ABEs should be considered among patients with TB who experience abdominal discomfort with hyperbilirubinemia, especially patients who have older age or diabetes.
结核病仍然是全球主要的传染病之一。结核病治疗期间不良反应很常见。然而，关于治疗相关的急性胆道事件（如胆石症、胆道梗阻、急性胆囊炎和胆管炎）的报道很少。
我们首先报告了4例在抗结核治疗期间发生急性胆道事件的肺结核患者。腹部超声检查显示，3例患者有多个胆结石伴肝内胆管扩张，1例患者有胆囊炎。为了调查抗结核治疗期间急性胆道事件的发生率和危险因素，我们随后利用台湾国民健康保险研究数据库进行了一项全国性队列研究。
从该数据库中确定了1996年至2010年间的159,56名肺结核患者，其中195例（0.12%）在开始抗结核治疗后的180天内发生了急性胆道事件。逻辑回归分析显示，与急性胆道事件相关的危险因素是年龄较大（相对风险[RR]：每增加10岁为1.32[1.21-1.44]）和糖尿病（RR：1.59[1.19-2.13]）。
尽管急性胆道事件不常遇到，但对于出现腹部不适并伴有高胆红素血症的结核病患者，尤其是年龄较大或患有糖尿病的患者，应考虑到这一情况。
