目的 探讨抗结核药物导致肝损害的机制、危险因素、治疗及预防方法，为临床合理用药提供参考。方法 以抗结核药物、肝损害、肝损伤等词为检索词，检索中国知网、万方医学和维普医学数据库，收集2015—2020年抗结核药物导致药物性肝损害的文献进行统计分析。结果 共收集到抗结核药物导致肝损害患者1 267例，男性患者799例（63.06%），女性患者468例（36.94%），患者年龄14～90岁。原发疾病均为结核病，发病时间为用药后7～90 d。临床表现以消化系统症状、乏力、皮疹、发热为主，有症状者694例（54.78%），无明显症状者573例（45.22%）。其中轻度肝损害患者839例（66.22%），中度肝损害患者346例（27.31%），重度肝损害患者82例（6.47%）。停药并给予保肝及对症治疗后，治愈1 142例（90.13%），好转122例（9.63%），死亡3例（0.24%）。结论 抗结核药物导致肝损害的发生率为11.03%，轻中度肝损害大多愈后良好，但要警惕重度肝损害及肝衰竭的发生。进行抗结核治疗时，须定期复查肝功能，以便早发现、早干预，有利于患者肝功能恢复，从而完成全程抗结核治疗，降低结核发病率。

Objective To explore the mechanism, risk factors, treatment and prevention of liver damage caused by antituberculosis drugs, and to provide references for rational clinical use of drugs. Methods Antituberculosis drugs, liver damage, liver damage and other words were used as search terms to search CNKI, Wanfang Medical and Weipu medical databases, and the literature of drug-induced liver damage caused by antituberculosis drugs from 2015 to 2020 were collected for statistical analysis. Results A total of 1 267 patients with liver damage caused by antituberculosis drugs were collected, including 799 male patients (63.06%) and 468 female patients (36.94%), aged 14-90 years. The primary diseases were all tuberculosis, and the onset time was 7-90 d after medication. The clinical manifestations were mainly digestive symptoms, fatigue, rash and fever, with symptoms 694 cases (54.78%) and 573 cases (45.22%) with no obvious symptoms. Among them, 839 patients (66.22%) had mild liver injury, 346 patients (27.31%) with moderate liver injury, 82 patients (6.47%) with severe liver injury. After drug withdrawal, liver protection and symptomatic treatment, 1 142 patients (90.13%) were cured, 122 patients were improved (9.63%), 3 patients deaths (0.24%). Conclusion The incidence of liver injury caused by antituberculosis drugs was 11.03%, and mild and moderate liver injury mostly recovered well, but the occurrence of severe liver damage and liver failure should be warned. During antituberculosis treatment, regular reexamination of liver function is required. The goal is early detection and early treatment. It is beneficial to the recovery of patients' liver function, so as to complete the whole anti-tuberculosis treatment and reduce the incidence of tuberculosis.

R977