van den Brande P, van Steenbergen W, Vervoort G, Demedts M
Division of Pneumology, University Hospital, University of Leuven, Belgium.
Am J Respir Crit Care Med. 1995 Nov;152(5 Pt 1):1705-8. doi: 10.1164/ajrccm.152.5.7582317.
We evaluated whether elderly patients with pulmonary tuberculosis and without apparent preexisting liver disease are at an increased risk to develop hepatotoxicity from an isoniazid-rifampin regimen and require regular liver function tests in comparison with younger patients. We analyzed the data of 131 patients treated in the period 1980-1985 of whom 64 (49%) were at least 60 yr of age. Subsequent increases of transaminases (measured weekly for as long as 4 wk after the start of treatment and later on when symptoms suggestive of hepatotoxicity occurred) above baseline values were found more frequently in the elderly (38 versus 18%, p < 0.05) and were also more pronounced in them (p < 0.01). The ratio of the highest transaminase value over the baseline value was called the transaminase index (TI). A TI of at least 5 was found in 22% of elderly and 8% of younger patients (p = NS), but ratios as high as 10 were mostly asymptomatic and always normalized progressively without treatment adjustment. Only symptomatic patients with a TI > or = 10 (five elderly and three younger) required temporary or definitive treatment adjustment. We conclude that repeated liver function test evaluations are generally unnecessary, except for symptomatic elderly and younger patients alike, in order to detect those with a TI > or = 10, thus requiring drug adjustment.
我们评估了患有肺结核且无明显既往肝病的老年患者，与年轻患者相比，接受异烟肼-利福平治疗方案时发生肝毒性的风险是否增加，以及是否需要定期进行肝功能检查。我们分析了1980年至1985年期间接受治疗的131例患者的数据，其中64例（49%）年龄至少为60岁。治疗开始后（最初4周每周测量，之后出现肝毒性症状时测量），转氨酶高于基线值的情况在老年患者中更常见（38%对18%，p<0.05），且升高幅度也更大（p<0.01）。最高转氨酶值与基线值之比称为转氨酶指数（TI）。22%的老年患者和8%的年轻患者TI至少为5（p=无显著性差异），但TI高达10的情况大多无症状，且在未调整治疗的情况下总是逐渐恢复正常。只有TI≥10的有症状患者（5例老年患者和3例年轻患者）需要临时或最终调整治疗。我们得出结论，除了有症状的老年和年轻患者外，一般无需反复进行肝功能检查评估，以检测出TI≥10从而需要调整药物的患者。
