tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.21292/2075-1230-2017-95-9-40-48tiblj-1044Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОЦЕНКА РИСКА И МОНИТОРИНГ ГЕПАТОТОКСИЧЕСКИХ РЕАКЦИЙ У БОЛЬНЫХ ТУБЕРКУЛЕЗОМRISK ASSESSMENT AND MONITORING OF HEPATOTOXIC REACTIONS IN TUBERCULOSIS PATIENTSИвановаД. А.IVАNOVАD. A.

ведущий научный сотрудник научно-клинического отдела Тел./факс: 8 (499) 268-50-10, 8 (495) 964-86-37

107014, Москва, ул. Стромынка, д. 10

Researcher of Research Clinical Department Phone/Fax: +7 (499) 268-50-10; +7 (495) 964-86-37

10, Stronymka St., Moscow, 107014

БорисовС. Е.BORISOVS. E.

заместитель директора по научно-клинической работе Тел./факс: 8 (499) 268-50-10, 8 (495) 964-86-37

107014, Москва, ул. Стромынка, д. 10

Deputy Director for Research and Clinical Activities Phone/Fax: +7 (499) 268-50-10; +7 (495) 964-86-37

10, Stronymka St., Moscow, 107014

info@cbt.mosgorzdrav.ruГБУЗ «Московский научно-практический центр борьбы с туберкулезом ДЗМ»РоссияMoscow Municipal Scientific Practical Center of Tuberculosis ControlRussian Federation2017101020179594048Copyright © Иванова Д.А., Борисов С.Е., 20172017Иванова Д.А., Борисов С.Е.IVАNOVА D.A., BORISOV S.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/1044

С целью выявления групп риска лекарственного поражения печени (ЛПП) и разработки схемы дифференцированного мониторинга печеночных тестов при проведении противотуберкулезной химиотерапии выполнено проспективное исследование, включившее 435 впервые выявленных больных туберкулезом. С помощью одномерного и регрессионного анализа выделены факторы риска ЛПП (женский пол, дефицит питания, отсутствие курения, лекарственная аллергия в анамнезе), на их основе построена и валидирована шкала балльной оценки риска ЛПП до начала химиотерапии. Развитие ЛПП отмечено у 110 больных (25,3%, 95%-ный ДИ 21,4-29,6%), из них у 45 (40,9%) пациентов на сроке до 14 дней от начала химиотерапии. В группе высокого риска ЛПП развивалось раньше; доля случаев «раннего» ЛПП (до 14 дней) в группе высокого риска составила 18,5%, в группе низкого риска – 6,6% (p = 0,02). С целью ранней диагностики ЛПП предложена схема лабораторного мониторинга в зависимости от степени риска.

In order to detect risk groups for drug-induced liver lesions and to develop the procedure for differential monitoring of liver tests during tuberculosis chemotherapy, a prospective study was performed including 435 new tuberculosis patients. The one-dimensional and regression analysis helped to identify risk factors of drug-induced liver lesions (female sex, poor nutrition, absentation from smoking, history of medicamentous allergy), and based on them scores for risk assessment before the start of chemotherapy were worked out and validated. Drug-induced liver lesions developed in 110 patients (25.3%, 95% CI 21.4-29.6), of them 45 (40.9%) developed liver lesion during first 14 days after the start of chemotherapy. The group facing a higher risk of drug-induced liver lesions developed them after a longer period of time; the number of early liver lesions made 18.5% in the high-risk group, and 6.6% (p = 0.02) in the low-risk group. The procedure of laboratory monitoring depending on the degree of risk was offered for early diagnostics of drug-induced liver lesions.

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The authors declare that there are no conflicts of interest present.