目的 探討抗結(jié)核藥物導致肝損害的機制、危險因素、治療及預防方法，為臨床合理用藥提供參考。方法 以抗結(jié)核藥物、肝損害、肝損傷等詞為檢索詞，檢索中國知網(wǎng)、萬方醫(yī)學和維普醫(yī)學數(shù)據(jù)庫，收集2015—2020年抗結(jié)核藥物導致藥物性肝損害的文獻進行統(tǒng)計分析。結(jié)果 共收集到抗結(jié)核藥物導致肝損害患者1 267例，男性患者799例（63.06%），女性患者468例（36.94%），患者年齡14～90歲。原發(fā)疾病均為結(jié)核病，發(fā)病時間為用藥后7～90 d。臨床表現(xiàn)以消化系統(tǒng)癥狀、乏力、皮疹、發(fā)熱為主，有癥狀者694例（54.78%），無明顯癥狀者573例（45.22%）。其中輕度肝損害患者839例（66.22%），中度肝損害患者346例（27.31%），重度肝損害患者82例（6.47%）。停藥并給予保肝及對癥治療后，治愈1 142例（90.13%），好轉(zhuǎn)122例（9.63%），死亡3例（0.24%）。結(jié)論 抗結(jié)核藥物導致肝損害的發(fā)生率為11.03%，輕中度肝損害大多愈后良好，但要警惕重度肝損害及肝衰竭的發(fā)生。進行抗結(jié)核治療時，須定期復查肝功能，以便早發(fā)現(xiàn)、早干預，有利于患者肝功能恢復，從而完成全程抗結(jié)核治療，降低結(jié)核發(fā)病率。

Objective To explore the mechanism, risk factors, treatment and prevention of liver damage caused by antituberculosis drugs, and to provide references for rational clinical use of drugs. Methods Antituberculosis drugs, liver damage, liver damage and other words were used as search terms to search CNKI, Wanfang Medical and Weipu medical databases, and the literature of drug-induced liver damage caused by antituberculosis drugs from 2015 to 2020 were collected for statistical analysis. Results A total of 1 267 patients with liver damage caused by antituberculosis drugs were collected, including 799 male patients (63.06%) and 468 female patients (36.94%), aged 14-90 years. The primary diseases were all tuberculosis, and the onset time was 7-90 d after medication. The clinical manifestations were mainly digestive symptoms, fatigue, rash and fever, with symptoms 694 cases (54.78%) and 573 cases (45.22%) with no obvious symptoms. Among them, 839 patients (66.22%) had mild liver injury, 346 patients (27.31%) with moderate liver injury, 82 patients (6.47%) with severe liver injury. After drug withdrawal, liver protection and symptomatic treatment, 1 142 patients (90.13%) were cured, 122 patients were improved (9.63%), 3 patients deaths (0.24%). Conclusion The incidence of liver injury caused by antituberculosis drugs was 11.03%, and mild and moderate liver injury mostly recovered well, but the occurrence of severe liver damage and liver failure should be warned. During antituberculosis treatment, regular reexamination of liver function is required. The goal is early detection and early treatment. It is beneficial to the recovery of patients' liver function, so as to complete the whole anti-tuberculosis treatment and reduce the incidence of tuberculosis.

R977