【摘要】 目的　提高对抗结核药物治疗引起肝功能衰竭的认识 ,减少因抗结核治疗导致的肝衰竭和临床死亡的发生。方法　对 11例结核病抗结核治疗期发生急性肝衰竭死亡的病例和 2 2例严重肝功能损害经护肝治疗后恢复的病例的临床特点和实验室检查结果进行分析。结果　抗结核药物性所致急性肝衰竭多出现在抗结核治疗 3月以后 ,老年人多见 ,平均年龄 5 1.38± 14 .5 7岁 ,半数以上 (7/ 11)合并HBV感染 ,临床症状较明显 ,黄疸出现早而重 ,以黄疽指数升高为主的肝功能异常 ,晚期有明显的肝性脑病表现 ,腹膜炎腹水形成以及凝血酶原活动度显著降低。从症状出现到死亡时间为 6 6 .5±4 4.5d。结论　重视和监测结核病化疗引起的肝功能损害 ,对有肝功能损害尤其是以黄疸为主要表现者要及早停药进行综合护肝治疗。黄疸指数 (TBIL)比ALT及AST在指导临床治疗和判断预后更有意义。更多还原

【Abstract】 Objective To discuss the effect on liver failure caused by antitubercular drugs.Methods The 11 cases of acute liver failure ended death (death group) and 22 cases of severe liver function damage ended recovery (recovery group),both caused by antitubercular drugs,were analyses.Results The age, positive rate of HBsAg, the TBIL level and the time from the emergence of hepatitis symptom to the treatment of drug hepatitis in the death groups is significantly larger or higher or longer than those of recovery group ( P <0.05).But the difference of ALT and AST level and the copies of HBV DNA level is not significant. The development of acute fulminant liver failure ended death was related to the following factors: aged patients, HBV infection before treatment, severe jaundice, ignorance and delayed treatment of liver function damage.Conclusion These cases of liver failure the need for stricter adherence to current guidelines on liver function tests after starting anti-tuberculous therapies. TBIL level and prothrombin activity (PTA) is more important indicators than ALT/AST in prognosis. Liver function damage with mainly abnormal ALT/AST and without elevated TBIL level can be recovered by stop using RFP and PZA plus administration of protective liver therapy.更多还原