作　　者： (谷强业）; (王飞）; (杨建新）;

机构地区： 山东济宁市传染病医院结核科,山东济宁272031

出　　处： 《医学临床研究》 2017年第8期1483-1486,共4页

摘　　要： 【目的】研究吲哚菁绿排泄试验评估和预测耐药肺结核患者在抗结核治疗过程中的肝脏损伤的价值。【方法】回顾性分析2015年1月至2016年12月在本院结核科接受治疗的137例耐药肺结核患者的临床资料。在开始抗结核治疗前1天和治疗开始后的第1个月和第3个月分别进行吲哚菁绿（ICG）排泄试验来评估患者的肝脏功能，分别检测ICG血浆清除率（PDRICG）PDRKG和ICG的15min滞留率（R15m），并且与常规肝功能指标相比较。【结果】抗结核治疗开始1个月后，患者的PDR-CG明显降低，R15ICG明显增加（P=0．007，0．001）。在治疗后3个月，PDRICG和R15ICG明显恢复，几乎恢复到了治疗前的水平（P=0．002，0．001）。发生了肝脏损伤的治疗前的PDRICG和R15ICG水平明显更差（P=0．01，0．016）。在开始治疗前，治疗开始后的第1个月和第3个月的PDRICG和R15ICG与相应时间点的Tbil（r=0．816和0．1767，P〈0．001）显著性正相关，与PA（r=-0．312和-0．423，P〈0．001）和ALB（r=-0．231和-0．177，P〈0．001）显著性负相关，而与ALT、AST、PT、INR之间没有明显相关性（P〉0．05）。【结论】PDR和R15是评价耐药肺结核患者在抗结核治疗过程中的肝脏损伤的有价值的临床试验，值得在临床大力推广使用。 [Objective] To assess the value of indocyanine green excretion test in predicting liver injury in patients of multidrug-resistant tuberculosis（MDR-TB） during antituberculosis treatment.[Methods]Clinical data of 137 patients with drug-resistant pulmonary tuberculosis treated in our hospital from January 2015 to December 2016 were analyzed retro- spectively, ld before the start of antituberculosis treatment and the first month and the third month after the start of treatment, indocyanine green （ICG） excretion test was carried out respectively to assess the patient＇s liver function; The ICG plasma clearance rate （PDRICG） and the 15 rain retention rate （R15ICG） of ICG were detected and compared with the conventional liver function index.[Results]One month of after anti TB treatment, the patienfs PDRIcG decreased signifi- cantly and R15ICG increased significantly （ P = 0.007, 0.001 ） ; 3 months after treatment, PDRICG and R15icc recovered significantly and almost returned to pre treatment levels （ P =0.002,0.001） ; The levels of PDRICG and R15ICG were significantly worse before treatment （ P =0.01,0.016） in patients with liver injury; Before the start of treatment, and in the first month and three months after the start of treatment, the PDR^c6 and R15~o~ were significantly positively correlated with the corresponding time points of TBil （ r = 0.816 and 0.1767, P 〈0.001）, and significantly negatively correlated with PA （ r =-0.312 and -0.423, P 〈 0.001） and ALB （ r =-0.231 and -0.177, P 〈0.001）; there was no sig- nificant correlation between ALT, AST, PT, and INR （ P 〉0.05）.[Conclusion] PDR and R15 are valuable clinical trials to evaluate the liver injury in drug-resistant tuberculosis patients during anti-tuberculosis treatment and are worthy of pop- ularization in clinical practice.

关 键 词： 吲哚花青绿 代谢 结核 肺 药物疗法 药物耐受性 肝 损伤 抗结核药