CAJ | 학술논문

目的比较抗结核药物诱导肝损伤后两种不同给药方案药物性肝损伤再发率.方法将88例符合抗结核药物诱导肝损伤诊断标准患者随机分成2组(A组、B组),每组各44例,A组按最初治疗方案重新开始予以异烟肼、利福平、吡嗪酰胺及乙胺丁醇全剂量给药,B组在乙胺丁醇及左氧氟沙星及链霉素治疗的基础上予以异烟肼、利福平按逐步增加药物种类及剂量的方法给药,待异烟肼及利福平耐受后停用链霉素,观察比较不同治疗方案药物性肝损伤再发率.结果 A组10人再发肝损伤(22.7％),B组3人再发肝损伤(6.8％),两组再发肝损伤率比较差异有统计学意义(x2=4.42,P＜0.05),A组中2人因肝损伤严重退出实验,其他8人改用B组治疗方案后均顺利完成治疗,无人再次出现肝功能损伤.结论包含吡嗪酰胺的一次性全剂量的再次给药方案更易导致再次肝损伤.不包含吡嗪酰胺,且异烟肼、利福平逐步增加剂量和种类的给药方案具有更小的再次肝损伤发生率.
목적 비교항결핵약물유도간손상후량충불동급약방안약물성간손상재발솔.방법 장88례부합항결핵약물유도간손상진단표준환자수궤분성2조(A조、B조),매조각44례,A조안최초치료방안중신개시여이이연정、리복평、필진선알급을알정순전제량급약,B조재을알정순급좌양불사성급련매소치료적기출상여이이연정、리복평안축보증가약물충류급제량적방법급약,대이연정급리복평내수후정용련매소,관찰비교불동치료방안약물성간손상재발솔.결과 A조10인재발간손상(22.7％),B조3인재발간손상(6.8％),량조재발간손상솔비교차이유통계학의의(x2=4.42,P＜0.05),A조중2인인간손상엄중퇴출실험,기타8인개용B조치료방안후균순리완성치료,무인재차출현간공능손상.결론 포함필진선알적일차성전제량적재차급약방안경역도치재차간손상.불포함필진선알,차이연정、리복평축보증가제량화충류적급약방안구유경소적재차간손상발생솔.
Objective To compare the efficacy of two different dosage regimens on hepatotoxicity recurrence in tuberculosis treatment.Methods Eighty-eight cases with antituberculosis drug-induced liver injury in according with diagnosis standard were divided into 2 groups (group A and group B).Patients in group A (n =44) were retreated with the same regimen (isoniazid,rifampicin,pyrazinamide and ethambutol) in the same dosages throughout.Patients in group B (n =44) were given isoniazid and rifampicin by gradually increasing the type and dosage of the drugs on the basis of ethambutol,levofloxacin and streptomycin.In group B,streptomycin was stopped when isoniazid and rifampicin were tolerated.The hepatotoxicity recurrence rates in different dosage regimens were observed.Results Hepatotoxicity recurred in 10(22.7％)and 3 (6.8％) patients in groups A and B (x2=4.42,P ＜ 0.05),respectively.Two patients in group A quit the treatment,because of the serious hepatotoxicity,the other 8 patients with recurrence of hepatitis received the same retreatment protocol as group B.By the end of retreatment,all patients were cured without hepatotoxicity again.Conclusions The recurrence rate of hepatotoxicity is higher in the full-dose regimen including pyrazinamide,which causes more hepatotoxicity than gradual reintroduction of a regimen without pyrazinamide.