基于child - turcote - pugh评分的改良抗结核治疗失代偿性肝硬化合并结核病患者：一项来自北印度的为期两年的回顾性观察研究

IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY

Indian Journal of Gastroenterology Pub Date : 2025-08-29 DOI:10.1007/s12664-025-01860-x

Juned Ahmad

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引用次数: 0

摘要

背景：失代偿期肝硬化患者的结核病管理具有挑战性，因为如果抗结核治疗（ATT）继发出现肝毒性，严重肝功能衰竭的风险显着增加。Dhiman等基于child - turcote - pugh （CTP）评分的ATT提出，在CTP评分≤7分、8-10分和≥11分时，肝毒性药物的数量分别为2、1和0。我们在此提出我们的回顾性观察研究，利用上述基于ctp的ATT方案治疗失代偿性肝硬化患者的结核病。方法：采用基于应用软件的电子数据检索方法，于2022年4月至2024年4月进行回顾性观察研究。在该软件上，失代偿性肝硬化合并肺结核患者已经被标记。改进的ATT方案（基于体重）是根据CTP评分。CTP评分≥11，无肝毒性药物纳入：强化期-ELA（乙胺丁醇、左氧氟沙星、阿米卡星）；延续阶段：EL。CTP评分8-10分时，纳入1种肝毒性药物（首选利福平）；强化期：RELA， R利福平；CTP评分≤7的患者接受两种肝毒性药物治疗，强化期：HREL、异烟肼，继续期：HRE。ATT延续阶段的持续时间为12-18个月。结果：155例失代偿性肝硬化患者中，21例（13.5%）合并结核。在强化阶段，对所有21例患者进行基于CTP评分的改良ATT。4例患者（19.1%）在强化期出现药物性肝毒性。强化期结束后，2例患者失访。在完成延续期的19名患者中，15名（78.9%）患者的结核病得到缓解，4名（21.1%）患者死亡。4例患者的死亡原因均与肝硬化有关。结论：根据我们的研究，失代偿性肝硬化患者耐受基于ctp评分的改良ATT，几乎80%的患者结核病得到了缓解。

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Child-Turcotte-Pugh score-based modified anti-tubercular treatment in patients with decompensated cirrhosis with tuberculosis: A two-year retrospective observational study from North India.

Background: Management of tuberculosis in decompensated cirrhosis is challenging, as the risk of severe liver failure is markedly increased if hepatotoxicity develops secondary to anti-tubercular treatment (ATT). Child-Turcotte-Pugh (CTP) score-based ATT by Dhiman et al. proposed that the number of hepatotoxic drugs should be two, one and none in CTP scores of ≤ 7, 8-10 and ≥ 11, respectively. We present here our retrospective observational study of treating tuberculosis in patients with decompensated cirrhosis utilizing the above-mentioned CTP-based ATT regimens.

Methods: A retrospective observational study utilizing electronic data search was conducted on the application-based software for the duration from April 2022 to April 2024. On the software, decompensated cirrhosis with tuberculosis patients were already tagged. The modified ATT regimens (weight-based) were as per the CTP score. With CTP score ≥ 11, no hepatotoxic drug was included: Intensive Phase -ELA (Ethambutol, Levofloxacin and Amikacin); Continuation Phase: EL. With CTP scores 8-10, 1 hepatotoxic drug (rifampicin preferred) was included; Intensive Phase: RELA, R Rifampicin; Continuation Phase: REL. CTP score ≤ 7 received two hepatotoxic drugs, Intensive Phase: HREL, H Isoniazid, Continuation Phase: HRE. The duration of ATT's continuation phase was 12-18 months.

Results: Of 155 patients with decompensated cirrhosis, 21 (13.5%) had concomitant tuberculosis. CTP score-based modified ATT was administered to all 21 during the Intensive phase. Drug-induced hepatotoxicity developed in four patients (19.1%) during the intensive phase. After the intensive phase, two patients were lost to follow-up. Out of 19 patients who completed the continuation phase, 15 (78.9%) had a resolution of tuberculosis and four (21.1%) died. The cause for death in all four patients was related to cirrhosis.

Conclusion: As per our study, patients with decompensated cirrhosis tolerated the CTP-score-based modified ATT and almost 80% had a resolution of tuberculosis.

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来源期刊

Indian Journal of Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

3.90

自引率

10.00%

发文量

期刊介绍： The Indian Journal of Gastroenterology aims to help doctors everywhere practise better medicine and to influence the debate on gastroenterology. To achieve these aims, we publish original scientific studies, state-of -the-art special articles, reports and papers commenting on the clinical, scientific and public health factors affecting aspects of gastroenterology. We shall be delighted to receive articles for publication in all of these categories and letters commenting on the contents of the Journal or on issues of interest to our readers.