异烟肼与吡嗪酰胺联合抗结核治疗对肝功能的影响Influence of Isoniazid Combined with Pyrazinamide on the Liver Function During Antituberculous Treatment
张玲,周英,李凌华,郭凤霞
ZHANG Ling,ZHOU Ying,LI Ling-hua,GUO Feng-xia (Guangzhou No.8 People's Hospital
摘要(Abstract)：
目的了解异烟肼与吡嗪酰胺联合抗结核治疗对肝功能的影响。方法将81例因结核病化学治疗导致的药物性肝炎分为异烟肼(H)、利福平(R)、吡嗪酰胺(Z)联合化疗组与HR化疗组,分析比较两组的临床特点。结果HRZ联合化疗组暴发型肝炎的发生率为31%(16/51),死亡率为22%(11/51);HR化疗组暴发型肝炎的发生率及死亡率较低,分别为20%(6/30)、17%(5/30),但两组比较差异无统计学意义(P>0.05)。肝功能指标比较,HRZ联合化疗组肝功能损害程度明显大于HR化疗组:血清白蛋白(ALB)及凝血酶原活动度(PTA)两组比较差异有显著性(P<0.05)。结论异烟肼与吡嗪酰胺均有明显的肝脏毒性,联合用药可增加肝功能损害,一旦引起暴发型肝炎病死率极高,值得临床重视。
Objective To study the influence of isoniazid combined with pyrazinamide on the liver function during antituberculous treatment.Method 81 patients with hepatitis caused by antituberculous therapy were divided into two groups to investigate and compare their clinical characteristics respectively,one group received isoniazid and rifampicin together with pyrazinamide(group 1),the other received isoniazid and rifampicin without pyrazinamide (group 2).Results The morbidity and mortality of fulminant hepatitis was both higher in group 1(31% and 22%) than that in group 2(20% and 17%).But there were no significant differences between two groups(P﹥0.05).The damage to liver function was more serious in group 1 than that in group 2: the figures of serum albumin(ALB) and plasma thromboplastin activity(PTA) had significant differences between two groups(P<0.05).Conclusion Isoniazid and pyrazinamide are well known apparently as hepatoxic drugs and their co-administration will give more damage to liver function.Once they cause fulminant hepatitis,the mortality is great.
关键词(KeyWords)：
抗结核药;肝炎
antituberculous drugs;hepatitis
基金项目(Foundation):
作者(Author):
张玲,周英,李凌华,郭凤霞
ZHANG Ling,ZHOU Ying,LI Ling-hua,GUO Feng-xia (Guangzhou No.8 People's Hospital
参考文献(References)：
- [1]蔡纪明,陈贤义.中国结核病控制工作典范———世界银行贷款传染病与地方病控制项目结核病控制部分终期评价报告[M].北京:人民卫生出版社,2003:17-21.
- [2]卫生部疾病控制司,卫生部医政司.全国结核病防治工作手册(1999年修订本)[S].1999:53-60.
- [3]季伟.药物性肝损伤的治疗[M]//王慧芬,王业东.肝脏疾病.北京:科学技术文献出版社,2001:404-420.
- [4]Durand F,Bernuau J,Pessayre D,et al.Deleterious Influ-ence of Pyrazinam ide on the Outcom e of Patients W ith Fu l-m inant or Subu lm inant L iver Failure During Antitubercu lousTreatm ent Inc lud ing Ison iazid[J].Hepatology,1995,27(4):929-932.
- [5]WU Jaw-ch ing,LEE Shou-dong,YEH-Pen-feng,et al.Iso-n iazid-R ifamp in-Induced Hepatitis in Hepatitis B Carriers[J].Gastroenterology,1990,89:502-504.