【摘要】 目的 系统评价抗结核药物性肝损伤（ATB-DILI）发生率及其危险因素。方法 检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、维普网、万方数据、中国生物医学文献数据库，收集抗结核药物治疗结核后发生ATB-DILI及其危险因素分析的病例对照研究和队列研究，检索时限为建库至2024年5月31日。筛选文献、提取数据，评价文献质量后，采用Stata 17.0软件和RevMan 5.3软件进行Meta分析。结果 共纳入26篇文献，涉及38 971例患者，其中ATB-DILI患者为4 106例。Meta分析结果显示，ATB-DILI发生率为12.94%[95%CI(10.82%,15.06%),P<0.001]；亚组分析显示，在队列研究、中国研究、儿童患者中ATB-DILI发生率更高（P<0.001）。年龄≥60岁、体重指数异常、嗜酒、吸烟、肝病史、乙肝表面抗原阳性、肺外结核、营养不良、低蛋白血症、心血管疾病、糖尿病、系统性红斑狼疮、未预防性使用保肝药、丙氨酸转氨酶基线水平高对发生ATB-DILI均有显著影响（P<0.05）。敏感性分析和发表偏倚分析结果显示，本研究所得结果稳健可靠。结论 结核患者使用抗结核药物治疗后的ATB-DILI发生率为12.94%；年龄≥60岁、体重指数异常、嗜酒、吸烟、肝病史、乙肝表面抗原阳性、肺外结核、营养不良、低蛋白血症、心血管疾病、糖尿病、系统性红斑狼疮、未预防性使用保肝药、丙氨酸转氨酶基线水平高均是发生ATB-DILI的危险因素。更多还原

【Abstract】 OBJECTIVE To systematically evaluate the incidence of anti-tuberculosis drug-induced liver injury(ATB-DILI) and its risk factors. METHODS PubMed, Embase, the Cochrane Library, Web of Science, China Knowledge Network, VIP, Wanfang data and China Biomedical Literature Database were searched to collect cohort studies and case-control studies on the incidence and risk factors of ATB-DILI from the establishment of the database to 31 May 2024. After screening literature, extracting data and evaluating the quality of literature, meta-analysis was performed using Stata 17.0 and RevMan 5.3 software. RESULTS A total of 26 literature involving 38 971 patients were included, of which 4 106 patients suffered from ATB-DILI. Meta-analysis showed that the incidence of ATB-DILI was 12.94% [95%CI(10.82%,15.06%), P<0.001]; subgroup analysis showed that the incidence of ATB-DILI in cohort studies, Chinese studies and pediatric patients was higher(P<0.001). Age≥60 years, abnormal body mass index, alcoholism, smoking, history of liver disease, hepatitis B surface antigen positivity, extrapulmonary tuberculosis, malnutrition, hypoproteinemia, cardiovascular disease, diabetes mellitus, systemic lupus erythematosus, no prophylactic use of hepatoprotective drugs, and high baseline alanine transaminase levels were risk factors for developing ATB-DILI(P<0.05). Sensitivity analysis and publication bias analysis showed that the results obtained in this study were relatively robust.CONCLUSIONS The incidence of ATB-DILI in tuberculosis patients is 12.94%. Age≥60 years, abnormal body mass index, alcoholism, smoking, history of liver disease, hepatitis B surface antigen positivity, extrapulmonary tuberculosis, malnutrition,hypoproteinaemia, cardiovascular disease, diabetes mellitus, systemic lupus erythematosus, non-prophylactic use of hepatoprotective medications, and high baseline levels of alanine transaminase are the risk factors for developing ATBDILI.更多还原