Influencing factors for drug-induced liver injury among patients with pulmonary tuberculosis in Ningbo City
YANG Tianchi1, LI Shuting2, CHEN Qin3, CHEN Tong1, CHE Yang1
1. Department of Tuberculosis Control and Prevention, Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang 315010, China; 2. Ningbo University, Ningbo, Zhejiang 315211, China; 3. Ningbo Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang 315010, China
Abstract：Objective To investigate the factors affecting drug-induced liver injury among patients with pulmonary tuberculosis in Ningbo City from 2015 to 2019, so as to provide insights into the prevention of drug-induced liver injury. Methods Demographic features, presence of drug-induced liver injury, and disease history prior to anti-tuberculosis therapy were captured from patients with pulmonary tuberculosis in Ningbo City from 2015 to 2019 through the Tuberculosis Management Information System of the Chinese Disease Control and Prevention Information System and Ningbo Regional Diagnosis and Treatment Information Platform. Factors affecting drug-induced liver injury was identified using the multivariable logistic regression analysis. Results A total of 9 397 patients with pulmonary tuberculosis were enrolled, among whom 66.43% ( 6 242 case ) were male, 65.89% ( 6 192 cases ) were at ages of <60 years, and 92.35% ( 8 678 cases ) were treatment-naïve. There were 1 425 patients with drug-induced liver injury (15.16% incidence), including 729 cases with grade 1 (51.16%), 24 cases with grade 2 (1.68%), 7 cases with grade 3 (0.49%), 7 cases with grade 4 ( 0.49% ), and 658 cases with ungraded drug-induced liver injury ( 46.18% ). The median duration between drug administration and development of drug-induced liver injury was 24 ( interquartile range, 44 ) days. Multivariable logistic regression analysis identified treatment-naïve ( OR=1.464, 95%CI: 1.153-1.859 ) and history of liver disease ( OR=2.001, 95%CI: 1.709-2.342) as risk factors for drug-induced liver injury in patients with pulmonary tuberculosis. Conclusion The incidence of drug-induced liver injury was 15.16% among pulmonary tuberculosis patients in Ningbo City from 2015 to 2019. Treatment-naïve and a history of liver disease are associated with drug-induced liver injury among patients with pulmonary tuberculosis.
[1] LOW E,ZHENG Q,CHAN E,et al.Drug induced liver injury:East versus West-a systematic review and meta-analysis[J].Clin Mol Hepatol,2020,26(2):142-154. [2] 中华医学会结核病学分会.抗结核药物性肝损伤诊治指南(2019年版)[J].中华结核和呼吸杂志,2019,42(5):343-356. Chinese Medical Association Tuberculosis Branch.Guidelines for the diagnosis and treatment of anti-tuberculosis drug-induced liver injury(2019 edition)[J].Chin J Tuberc Respir Dis,2019,42(5):343-356. [3] SHEN T,LIU Y,SHANG J,et al.Incidence and etiology of drug-induced liver injury in Mainland China[J].Gastroenterology,2019,156(8):2230-2241. [4] 中华人民共和国卫生部.肺结核诊断标准:WS 288—2008[S].2008. Ministry of Health of the People's Republic of China.Diagnostic criteria for pulmonary tuberculosis:WS 288-2008[S].2008. [5] 中华人民共和国国家卫生和计划生育委员会.肺结核诊断:WS 288—2017[S].2017. National Health and Family Planning Commission of the People's Republic of China.Diagnostic for pulmonary tuberculosis:WS 288-2017[S].2017. [6] 中华医学会结核病学分会,《中华结核和呼吸杂志》编辑委员会.抗结核药所致药物性肝损伤诊断与处理专家建议[J].中华结核和呼吸杂志,2013,36(10):732-736. Chinese Medical Association Tuberculosis Branch,Chinese Journal of Tuberculosis and Respiration Editorial Committee.Expert advice on the diagnosis and treatment of drug-induced liver injury caused by anti-tuberculosis drugs[J].Chin J Tuberc Respir Dis,2013,36(10)：732-736. [7] 刘亚洁,张燕,陈阳贵,等.SLC11A1基因多态性与肺结核治疗失败的关联分析[J].预防医学,2021,33(6):563-567. LIU Y J,ZHANG Y,CHEN Y G,et al.The association between SLC11A1 gene polymorphism and treatment failure of pulmonary tuberculosis[J].Prev Med,2021,33(6):563-567. [8] 王云霞,郑娟娟,张娟娟,等.2011—2018年宝安区肺结核患者耐多药的影响因素分析[J].预防医学,2021,33(7):701-703. WANG Y X,ZHENG J J,ZHANG J J,et al.Influencing factors of multidrug resistance of patients with tuberculosis in Baoan District from 2011 to 2018[J].Prev Med,2021,33(7):701-703. [9] 刘芳,臧珊珊,刘永梅,等.抗结核治疗致肺结核患者药物性肝损伤的危险因素分析[J].解放军医药杂志,2019,31(9):56-59. LIU F,ZANG S S,LIU Y M,et al.Risk factors of drug-induced hepatic injury in tuberculosis patients after anti-tuberculosis therapy[J].Med Pharm J Chin PLA,2019,31(9):56-59. [10] 迟旭,漆沄,陈娟,等.初次抗结核治疗诱发药物性肝损伤临床特点及发病危险因素的logistic回归分析[J].陕西医学杂志,2019,48(1):67-70. CHI X,QI Y,CHEN J,et al.Logistic regression analysis of the clinical characteristics and risk factors of drug-induced liver injury induced by the first anti-tuberculosis treatment[J].Shaanxi Med J,2019,48(1):67-70. [11] ZHAO H,WANG Y B,ZHANG T,et al.Drug-induced liver injury from anti-tuberculosis treatment:a retrospective cohort study[J].Med Sci Monit,2020,26[2021-10-09].https://pubmed.ncbi.nlm.nih.gov/32145061.DOI:10.12659/MSM.920350. [12] XU L,CHEN J,INNES A L,et al.Prescription practice of anti-tuberculosis drugs in Yunnan,China:a clinical audit[J].PLoS One,2017,12(10)[2021-10-09].https://pubmed.ncbi.nlm.nih.gov/29088241.DOI:10.1371/journal.pone.0187076. [13] KIM W S,LEE S S,LEE C M,et al.Hepatitis C and not Hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury[J].BMC Infect Dis,2016,16[2021-10-09].https://pubmed.ncbi.nlm.nih.gov/26833347.DOI:10.1186/s12879-016-1344-2. [14] 李凌未,马凌飞,李胜前.412例抗结核药物导致肝损害的临床评价分析[J].药物流行病学杂志,2016,25(12):773-776. LI L W,MA L F,LI S Q.Retrospective clinical evaluation of anti-tuberculosis drug induced liver injury[J].J Pharmacoepidemiol,2016,25(12):773-776.
