Pande J N, Singh S P, Khilnani G C, Khilnani S, Tandon R K
Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Thorax. 1996 Feb;51(2):132-6. doi: 10.1136/thx.51.2.132.
Several risk factors for the development of hepatotoxicity during short course antituberculosis therapy have been suggested. A case-control study was undertaken to assess the role of age, sex, disease extent, nutritional status, past history of liver disease, infection with hepatitis viruses, acetylator status, and high alcohol intake as risk factors in the development of hepatotoxicity in patients with pulmonary tuberculosis receiving antituberculosis treatment.
The cases comprised 86 consecutive patients who were diagnosed as having hepatitis induced by antituberculosis drugs and who were negative for any of the hepatitis markers (HAV-IgM, HBsAg, HBc-IgM, and anti-HCV). The control group comprised 406 consecutive patients attending the chest clinic who completed antituberculosis treatment without developing hepatitis. The variables analysed were age, sex, body mass index (BMI), history of high alcohol intake, radiological extent of the disease, acetylator status, and serum proteins.
The cases were older and their serum albumin levels were lower than in the control group. High alcohol intake was more common among the cases, they had more extensive disease radiologically, and the proportion of slow acetylators was higher. No differences were observed between the two groups in the other risk factors analysed.
Of the various risk factors analysed, only advanced age, hypoalbuminaemia, high alcohol intake, slow acetylator phenotype, and extensive disease were risk factors for the development of hepatotoxicity. The risk of hepatitis in the presence of one or more of these risk factors may be increased.
已有研究提出了短程抗结核治疗期间发生肝毒性的若干危险因素。开展了一项病例对照研究，以评估年龄、性别、疾病范围、营养状况、既往肝病病史、感染肝炎病毒、乙酰化状态及高酒精摄入量作为接受抗结核治疗的肺结核患者发生肝毒性的危险因素所起的作用。
病例组包括86例连续诊断为抗结核药物所致肝炎且肝炎标志物（甲型肝炎病毒IgM、乙型肝炎表面抗原、乙型肝炎核心抗体IgM及抗丙型肝炎病毒）均为阴性的患者。对照组包括406例连续在胸科门诊就诊、完成抗结核治疗且未发生肝炎的患者。分析的变量有年龄、性别、体重指数（BMI）、高酒精摄入史、疾病的放射学范围、乙酰化状态及血清蛋白。
病例组患者年龄更大，血清白蛋白水平低于对照组。病例组中高酒精摄入更为常见，放射学检查显示疾病范围更广，慢乙酰化者比例更高。在分析的其他危险因素方面，两组之间未观察到差异。
在所分析的各种危险因素中，只有高龄、低白蛋白血症、高酒精摄入、慢乙酰化表型及广泛病变是发生肝毒性的危险因素。存在一个或多个这些危险因素时肝炎发生风险可能增加。
