Thompson N P, Caplin M E, Hamilton M I, Gillespie S H, Clarke S W, Burroughs A K, McIntyre N
University Dept of Medicine, Royal Free Hospital School of Medicine, London, UK.
Eur Respir J. 1995 Aug;8(8):1384-8. doi: 10.1183/09031936.95.08081384.
In the light of three deaths due to liver failure secondary to anti-tuberculosis therapy at the Royal Free Hospital, we have reviewed the current literature, and asked--How common is liver dysfunction with anti-tuberculosis medications and how might it be prevented? Anti-tuberculosis chemotherapy is associated with abnormalities in liver function tests in 10-25% of patients. Clinical hepatitis develops in about 3%, though estimates vary, and in these patients there is likely to be significant morbidity and mortality. On the basis of reported cases of tuberculosis, 160 patients in England and Wales can be expected to develop drug-induced hepatitis due to anti-tuberculosis therapy each year. There are published guidelines from the British and American Thoracic Societies regarding the choice of drug therapy for tuberculosis. Current recommendations with regard to monitoring liver function, and what to do when these tests become abnormal, vary considerably. We suggest a protocol for using liver function tests to monitor for liver damage, and give recommendations on what action to take when these become abnormal.
鉴于皇家自由医院发生了3例因抗结核治疗继发肝衰竭导致的死亡病例，我们查阅了当前的文献，并提出疑问：抗结核药物导致肝功能障碍的情况有多常见？如何预防？抗结核化疗会使10%至25%的患者出现肝功能检查异常。临床肝炎的发生率约为3%，不过估计值有所不同，而且这些患者很可能出现严重的发病和死亡情况。根据报告的结核病病例，预计英格兰和威尔士每年有160名患者会因抗结核治疗而发生药物性肝炎。英美胸科学会已发布了关于结核病药物治疗选择的指南。目前关于监测肝功能以及肝功能检查结果异常时该如何处理的建议差异很大。我们提出了一项使用肝功能检查来监测肝损伤的方案，并就检查结果异常时应采取的措施给出了建议。
