Clinical Analysis Of Anti-tuberculosis Drug Induced Liver Injury In Children

Objective: analyzing the clinical characteristics of anti-tuberculosis drug induced liver injury in children,To explore the risk factors,clinical characteristics and prognostic factors.Methods: From 2014 to 2017,a total of 847 hospitalized children with tuberculosis in the affiliated Children's Hospital of Chongqing Medical University were studied.The medical records of 98 children with liver injury during the use of anti-tuberculousis drugs were retrospectively analyzed.Results: 1.The total incidence of liver damage caused by anti-tuberculosis drugs in this study was 11.5%.The risk factors of ATLI are age,tuberculosis type.The risk of ATLI in patients aged in 1-2 months and 3months-1years old was higher than that of 1-3,4-6 and 7-12 years old(P<0.05).Patients with miliaris phthisis and / or tubercular meningitis have a higher risk of ATLI than other sites of tuberculosis(P<0.05).There was no significant difference in the risk of ATLI in patients with different anti-tuberculosis drug selection and hepatoprotective therapy with different sex,different sites of tuberculosis involvement,and differentanti-tuberculosis drugs(P>0.05).2.There were 24 cases(24/98,24.5%)of liver damage in ATLI patients with less than 7 days,38 cases(38/98,38.8%)in 7-14 days,27 cases(27/98,27.5%)in 14-30 days,9 cases(9/98,9.2%)more than 30 days.3.The clinical manifestations of ATLI patients were vomiting,Spirit wilting,and nausea.There were 67 cases(66/98,67.3%)of mild liver damage and 31 cases(32/98,32.7%)of moderate liver damage.The factors influencing the severity of liver function are tuberculosis types.The risk of severe liver injury is higher in patients with miliaris phthisis and / or tubercular meningitis than in other parts of tuberculosis(P<0.05).4.The liver function indexes of 82 patients(82/98,83.6%)ATLI were completely restored to normal.The factors affecting the recovery time of liver function are age and type of tuberculosis.The recovery time of liver function of 7-12 years old patients is shorter than that of 1-3 years old and 4-6 years old patients.The recovery time of liver function in patients with miliaris phthisis and / or tubercular meningitis is greater than that of other tuberculosis patients(P < 0.05).There was no significant difference in liver function recovery time between patients with different gender,different severity of liver function,different locations of tuberculosis,anti-tuberculosis drugs,whether jaundice or whether they stopped(P>0.05).Conclusion: 1.TB patients at less than 1 years old are more likely to have ATLI.miliaris phthisis and / or tubercular meningitis are independentrisk factors for the onset of ATLI in children.2.90.8%ATLI occurs within30 days of anti-tuberculosis treatment.So,it is of great significance to monitor the liver function regularly.The early recommendations are 1times a week and 1 times a month to monitor the liver function in the middle and late stages.3.The clinical manifestations of ATLI were vomiting,spirit wilting,and nausea.The degree of liver damage in patients with miliaris phthisis and / or tubercular meningitis should be heavier than those in other areas.Therefore,it should be highly valued.4.After the occurrence of ATLI,most of the patients recovered to normal liver function after the treatment of liver preservation and drug withdrawal.In patients with miliaris phthisis and / or tubercular meningitis,the recovery time of liver function is longer than that of other tuberculosis patients(P<0.05).The recovery time of liver function of 7-12 years old patients is shorter than that of 1-6 years old patients(P<0.05).Therefore,it is of great significance to closely monitor liver function and stop using toxic anti-tuberculosis drugs in time for liver function recovery.