Ma Liangliang, Fan Henghua
Department of Infective Diseases, Beijing Geriatric Hospital, Beijing, China.
Orthopedics Department, The Fourth People's Hospital of Shenzhen, Shenzhen, China.
Am J Trop Med Hyg. 2024 Nov 5;112(1):135-142. doi: 10.4269/ajtmh.24-0248. Print 2025 Jan 8.
This study addressed the factors influencing liver injury in elderly patients newly diagnosed with pulmonary tuberculosis and diabetes after antituberculosis treatment. From January 2021 to June 2023, 218 elderly patients with early treatment of pulmonary tuberculosis (N = 218) combined with diabetes (N = 218) were collected as research subjects. All patients were treated with the same antituberculosis treatment regimen and were divided into a nonhepatotoxicity group (N = 92) and a hepatotoxicity group (N = 126) according to whether drug-induced liver injury occurred within 3 months after taking tuberculosis drugs. The levels of alanine aminotransferase and aspartate aminotransferase, total bilirubin, direct bilirubin, indirect bilirubin, albumin, lipoprotein(a), prothrombin time, and hemoglobin A1c (HbA1c) were detected by biochemical analyzer. The extent of pulmonary tuberculosis lesions was examined by computed tomography imaging. Influencing factors of antituberculosis drug-induced liver injury were analyzed by logistic multivariate analysis. The hepatotoxicity group exhibited a higher average age than the nonhepatotoxicity group (P <0.05). Additionally, there was a greater prevalence of patients with a history of alcohol consumption in the hepatotoxicity group than in the nonhepatotoxicity group (P <0.05). And the hepatotoxicity group showed a greater extent of tuberculosis lesions (P <0.05). Logistic multivariate analysis identified advanced age, body mass index of <18.5, lesion range of ≥2 lung lobes, history of alcohol consumption, and HbA1c of ≥8% as relevant factors associated with liver function impairment in older adults patients undergoing early treatment of pulmonary tuberculosis combined with diabetes after antituberculosis therapy. These findings underscore the importance of monitoring and addressing these factors during antituberculosis therapy in the elderly population to mitigate the risk of liver function impairment.
本研究探讨了初治肺结核合并糖尿病老年患者抗结核治疗后肝损伤的影响因素。收集2021年1月至2023年6月期间218例早期治疗的肺结核(N = 218)合并糖尿病(N = 218)老年患者作为研究对象。所有患者均采用相同的抗结核治疗方案,并根据服用抗结核药物后3个月内是否发生药物性肝损伤分为非肝毒性组(N = 92)和肝毒性组(N = 126)。采用生化分析仪检测丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、直接胆红素、间接胆红素、白蛋白、脂蛋白(a)、凝血酶原时间和糖化血红蛋白(HbA1c)水平。通过计算机断层扫描成像检查肺结核病变范围。采用logistic多因素分析抗结核药物性肝损伤的影响因素。肝毒性组的平均年龄高于非肝毒性组(P <0.05)。此外,肝毒性组饮酒史患者的患病率高于非肝毒性组(P <0.05)。且肝毒性组的结核病变范围更大(P <0.05)。logistic多因素分析确定高龄、体重指数<18.5、病变范围≥2个肺叶、饮酒史和HbA1c≥8%是初治肺结核合并糖尿病老年患者抗结核治疗后肝功能损害的相关因素。这些发现强调了在老年人群抗结核治疗期间监测和处理这些因素以降低肝功能损害风险的重要性。