赞比亚卢萨卡大学教学医院强化阶段抗结核治疗对患者肝脏和血液参数的影响

Glorious Mwaba, D. Munkombwe, P. Kaonga, M. Mubita
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引用次数: 0

摘要

目的和研究设计:赞比亚是结核病高负担国家。抗结核药物是结核病管理的主要手段。在其他情况下,也有一些与抗结核药物相关的血液学和肝脏不良反应的报告。不良事件具有医疗成本和发病率方面的影响。在大学教学医院的患者中,这些不良反应的发生率和严重程度尚未得到充分研究,因此本研究的目的是确定血液学和肝脏异常,并比较患者在治疗前和强化期结束后的参数。与异常相关的因素也被确定。2018年4月至2018年7月在胸科诊所进行了一项前瞻性纵向研究。研究患者随访2个月。在基线和随访时记录全血细胞计数和肝功能检查。根据2017年艾滋病部成人和儿科不良事件严重程度分级表对异常进行定义。数据分析采用SPSS 22.0版。参数比较采用配对t检验和Wilcoxon配对带符号秩检验。进行逻辑回归以确定预测异常的因素。p< 0.05为差异有统计学意义。结果:共纳入37例患者。男性占56.8%。患者平均年龄36.2岁(19 ~ 57岁),体重指数21.9 kg/m2。只有37.8%的患者在基线时痰涂片阳性。56.8%的患者合并感染HIV。45.9%的患者接受抗逆转录病毒治疗,45.2%的患者随访时出现1-3级天冬氨酸转氨酶紊乱,而基线时为29.7%。5.4%的患者在基线时有1-3级丙氨酸转氨酶紊乱,而9.7%的患者在随访时有1级。随访时1-2级贫血的患者较少(16.1%),而基线时62.2%的患者为1-4级贫血。随访时更多的患者(46.2%)出现血小板紊乱,而基线时为25.8%。与基线相比,更少的患者在随访中出现差异白细胞计数紊乱。血液学参数:血红蛋白浓度、红细胞压积、红细胞和白细胞、嗜酸性粒细胞和中性粒细胞计数在基线和随访时均有统计学显著差异。然而,红细胞指数无统计学差异。基线和随访时丙氨酸转氨酶水平的变化具有统计学意义。进行Logistic回归以确定年龄、性别、体重指数、HIV感染、抗逆转录病毒治疗、痰涂片状态和适当的基线全血细胞计数/肝功能检查参数对随访时研究患者血红蛋白浓度、白细胞计数和丙氨酸转氨酶紊乱的可能性的影响。预测血红蛋白浓度和白细胞计数的Logistic回归模型在统计学上不显著。没有预测变量与丙氨酸转氨酶紊乱的可能性相关。结论:本研究结果显示,随访时血液学和肝脏不良反应相对较少,严重程度大多为1-3级。在初始阶段,抗结核治疗对患者是相对安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Intensive Phase Antituberculous Therapy on Hepatic and Haematological Parameters in Patients at the University Teaching Hospital in Lusaka, Zambia
Objectives and study design: Zambia is a high tuberculosis burden country. Antituberculous medicines are the mainstay of tuberculosis management. There have been several reports of antituberculous drug-related haematological and hepatic adverse effects noted in other settings. Adverse events have healthcare cost and morbidity implications. Prevalence and severity of these adverse effects are understudied in patients at University Teaching Hospitals hence the purpose of this study was to identify haematological and hepatic abnormalities and compare parameters before treatment and after completion of the intensive phase among the patients. Factors associated with abnormalities were also determined. A prospective longitudinal study was undertaken at Chest Clinic between April 2018 and July 2018. Study patients were followed up for 2 months. Full blood count and liver function tests were recorded at baseline and at follow-up. Abnormalities were defined according to the 2017 Department of AIDS Table for Grading the Severity of Adult and Paediatric Adverse Events. Data were analysed using SPSS version 22.0. Paired t-test and Wilcoxon matched-pairs signed-rank test were used to compare parameters. Logistic regression was performed to determine factors that were predictive of abnormalities. A p< 0.05 was considered statistically significant. Results: A total of 37 patients were involved in the study. 56.8% of patients were male. The mean age of patients was 36.2 years (19 – 57 years) while body mass index was 21.9 kg/m2. Only 37.8% of patients were sputum smear-positive at baseline. 56.8% of patients had HIV co-infection. 45.9% of patients were on antiretroviral therapy.45.2% of patients had grade 1-3 aspartate transaminase derangements at follow-up compared to 29.7% at baseline. 5.4% of the patients had grade 1-3 alanine transaminase derangements at baseline while 9.7% of patients had grade 1 at follow-up. Fewer patients (16.1%) had grade 1-2 anaemia at follow-up while 62.2% of patients at baseline had grade 1-4 anaemia. More patients (46.2%) had platelet derangements at follow-up compared to 25.8% at baseline. Fewer patients had differential white cell count derangements at follow-up compared to baseline. Statistically significant differences in haematological parameters: haemoglobin concentration, haematocrit, red, and white cell, eosinophil and neutrophil counts at baseline and follow-up were found. However, no statistically significant differences in red cell indices were observed. Changes in alanine transaminase levels at baseline and follow-up were statistically significant. Logistic regression was performed to determine the effects of age, gender, body mass index, HIV infection, antiretroviral therapy, sputum smear status, and appropriate baseline full blood count/liver function test parameters on the likelihood of study patients having deranged haemoglobin concentration, white cell count and alanine transaminase at follow-up. Logistic regression models to predict deranged haemoglobin concentration and white cell count were statistically insignificant. None of the predictor variables were associated with the likelihood of derangements in alanine transaminase. Conclusion: Findings of this study show that haematological and hepatic adverse effects were relatively fewer at follow-up and were mostly grades 1-3 in severity. Antituberculous therapy is relatively safe for patients during the initial phase.
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