摘要
目的 系统评价抗结核药物性肝损伤(ATB-DILI)发生率及其危险因素.方法 检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、维普网、万方数据、中国生物医学文献数据库,收集抗结核药物治疗结核后发生ATB-DILI及其危险因素分析的病例对照研究和队列研究,检索时限为建库至2024年5月31日.筛选文献、提取数据,评价文献质量后,采用Stata 17.0软件和RevMan 5.3软件进行Meta分析.结果 共纳入26篇文献,涉及38 971例患者,其中ATB-DILI患者为4 106例.Meta分析结果显示,ATB-DILI发生率为12.94％[95％CI(10.82％,15.06％),P＜0.001];亚组分析显示,在队列研究、中国研究、儿童患者中ATB-DILI发生率更高(P＜0.001).年龄≥60岁、体重指数异常、嗜酒、吸烟、肝病史、乙肝表面抗原阳性、肺外结核、营养不良、低蛋白血症、心血管疾病、糖尿病、系统性红斑狼疮、未预防性使用保肝药、丙氨酸转氨酶基线水平高对发生ATB-DILI均有显著影响(P＜0.05).敏感性分析和发表偏倚分析结果显示,本研究所得结果稳健可靠.结论 结核患者使用抗结核药物治疗后的ATB-DILI发生率为12.94％;年龄≥60岁、体重指数异常、嗜酒、吸烟、肝病史、乙肝表面抗原阳性、肺外结核、营养不良、低蛋白血症、心血管疾病、糖尿病、系统性红斑狼疮、未预防性使用保肝药、丙氨酸转氨酶基线水平高均是发生ATB-DILI的危险因素.
Abstract
OBJECTIVE To systematically evaluate the incidence of anti-tuberculosis drug-induced liver injury(ATB-DILI)and its risk factors.METHODS PubMed,Embase,the Cochrane Library,Web of Science,China Knowledge Network,VIP,Wanfang data and China Biomedical Literature Database were searched to collect cohort studies and case-control studies on the incidence and risk factors of ATB-DILI from the establishment of the database to 31 May 2024.After screening literature,extracting data and evaluating the quality of literature,meta-analysis was performed using Stata 17.0 and RevMan 5.3 software.RESULTS A total of 26 literature involving 38 971 patients were included,of which 4 106 patients suffered from ATB-DILI.Meta-analysis showed that the incidence of ATB-DILI was 12.94％[95％CI(10.82％,15.06％),P＜0.001];subgroup analysis showed that the incidence of ATB-DILI in cohort studies,Chinese studies and pediatric patients was higher(P＜0.001).Age≥60 years,abnormal body mass index,alcoholism,smoking,history of liver disease,hepatitis B surface antigen positivity,extrapulmonary tuberculosis,malnutrition,hypoproteinemia,cardiovascular disease,diabetes mellitus,systemic lupus erythematosus,no prophylactic use of hepatoprotective drugs,and high baseline alanine transaminase levels were risk factors for developing ATB-DILI(P＜0.05).Sensitivity analysis and publication bias analysis showed that the results obtained in this study were relatively robust.CONCLUSIONS The incidence of ATB-DILI in tuberculosis patients is 12.94％.Age≥60 years,abnormal body mass index,alcoholism,smoking,history of liver disease,hepatitis B surface antigen positivity,extrapulmonary tuberculosis,malnutrition,hypoproteinaemia,cardiovascular disease,diabetes mellitus,systemic lupus erythematosus,non-prophy lactic use of hepatoprotective medications,and high baseline levels of alanine transaminase are the risk factors for developing ATB-DILI.
维普
万方数据