慢性肝病患者的潜在结核病治疗结果:一项回顾性队列研究
Lilian Tran1, Anand Shah1, Eugene J Kim1
1Rutgers NJMS Department of Medicine, Newark, NJ, USA.
Journal of clinical tuberculosis and other mycobacterial diseases
|December 3, 2025
概括
在慢性肝病 (CLD) 患者中治疗潜伏结核病感染 (LTBI) 是可行的. 较短的利法治疗方案比较长的异化治疗方案更安全,降低了药物诱导性肝损伤 (DILI) 风险.
科学领域:
- 肝病学和传染病的研究
- 临床药理学和治疗学
背景情况:
- 慢性肝病 (CLD) 增加了潜伏结核病感染 (LTBI) 再激活的风险.
- 由于潜在的药物诱导性肝损伤 (DILI) 和有限的临床指南,在CLD患者中治疗LTBI具有挑战性.
- 这项研究调查了DILI发生率,治疗完成率,以及LTBI治疗中肝硬化与非肝硬化CLD患者的不良事件.
研究的目的:
- 为了比较接受LTBI治疗的肝硬化和非肝硬化CLD患者之间的DILI发病率,治疗完成率和不良事件.
- 在这个患者群体中识别与不良事件和DILI相关的风险因素.
- 评估不同LTBI治疗方案在CLD患者中的安全性和有效性.
主要方法:
- 一项单一中心的回顾性研究分析了2016年至2024年期间开始LTBI治疗的CLD患者的数据.
- 数据收集包括人口统计,并发症,LTBI诊断 (医生文档或IGRA),CLD病因,治疗方案和通过图表审查的结果.
- 使用美国DILI网络标准或治疗改变来定义DILI; LTBI是通过医生文档或积极的干扰素-释测试 (IGRA) 来诊断的.
主要成果:
- 在70名CLD患者中,有24名 (34.3%) 患有肝硬化. 总体而言,LTBI治疗完成率为67.1%,在肝硬化患者中显著下降 (50.0%与76.1%,p=0.035).
- 副作用发生在38.6%的人群中,DILI发生在20.0%的人群中. 慢性病 (CKD) 阶段≥3与更多不良事件相关 (p=0.029).
- 六个月的异化治疗显示了较高的DILI风险 (OR 7.21) 与四个月的利法治疗相比 (p=0.019). 肝硬化并没有独立预测DILI.
结论:
- 尽管存在并发性疾病,但在CLD患者中,LTBI治疗是可以实现的,并且通常耐受良好.
- 肝硬化与较低的治疗完成率有关,但没有增加DILI风险.
- 在CLD患者中,较短的,基于利法素的LTBI疗法比较安全,更好地耐受,比较长的,基于异化的疗法更好.
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