Relationship between pyrazinamide plasma concentration and liver injury in patients with tuberculosis
10.3760/cma.j.issn.1008-5734.2017.04.003
- VernacularTitle:初治结核病患者吡嗪酰胺血药浓度与肝损伤的关系
- Author:
Liang ZHANG
1
;
Feishen LIN
;
Qiuyun ZHOU
;
Hongzi DING
;
Jie WANG
Author Information
1. 210029,东南大学医学院附属南京胸科医院药学部
- Publication Type:Journal Article
- Keywords:
Pyrazinamide;
Drug-induced liver injury;
Tuberculosis
- From:
Adverse Drug Reactions Journal
2017;19(4):256-259
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the relationship between pyrazinamide plasma concentration and liver injury in patients with tuberculosis and explore the early prediction method of drug-induced liver injury (DILI) in initial treatment in patients with tuberculosis.Methods Data of tuberculosis patients (all the patients were initially treated, no other complications, and underlying disease) receiving 2HREZ/4HR treatment regimen [isoniazid, rifampicin, ethambutol, and pyrazinamide were given at the first 2 months of treatment, isoniazid and rifampicin were given at the later 4 months of treatment] in Nanjing Chest Hospital, Medical School of Southeast University from January to December 2016 were collected.According to the pyrazinamide concentration in serum on the 6th day of treatment, patients were divided into 3 groups, the <20 mg/L group, 20-40 mg/L group, and >40 mg/L group.The incidences of DILI in the 3 groups were compared.Results A total of 45 patients in accordance with the criteria were collected, including 33 males and 17 females with age from 18 to 50 years and an average age of (34±10) years.Among them, 36 patients had pulmonary tuberculous, 9 patients had tuberculous pleurisy, and 5 patients had tuberculosis meningitis.The pyrazinamide concentrations in serum were 16-51 mg/L and the average concentration was (35±9) mg/L.There were 4 patients in the <20 mg/L group, 28 patients in the 20-40 mg/L group, and 13 patients in the >40 mg/L group.Of the 45 patients, 11 patients developed DILI and the incidence was 24.4%.The pyrazinamide plasma concentrations in the 11 patients with DILI were 26 mg/L to 51 mg/L, 4 patients′ concentrations were 40 mg/L and 7 patients′ concentrations were >40 mg/L.The incidences of DILI in the <20 mg/L, 20-40 mg/L, and >40 mg/L groups were 0/4, 14.2 %(4/28), and 53.85% (7/13), respectively.The difference between the 20-40 mg/L and the >40 mg/L groups was statistically significant (X2=7.708, P=0.008).Conclusions The DILI incidence in initial treatment of tuberculosis patients increased with increase of pyrazinamide plasma concentration.Early therapeutic drug monitoring for pyrazinamide could predict the occurrence of DILI and was beneficial for reducing or avoiding the effect of DILL for tuberculosis treatment.
