預測抗結核藥物治療期間肝毒性之評分系統的建立. 中文摘要 結核病(Tuberculosis or TB)是目前全球性公共衛生的重要議題， 而目前結核病需要至少6個月密集且多重藥物合併的療程，此種治療雖然可以獲得極佳的臨床療效，但是治療期間病患發生肝毒性的比例卻相當高，然而肝毒性產生的機轉及與危險因子的關聯性尚未完全確立，也缺乏相關研究以藉由高危險族群預測其肝毒性的發生，因此，藉由進一步確認兩者的關聯性，將有助於臨床工作。
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A Method of Predicting Hepatotoxicity during Antituberculosis Therapy
Advanced clarify the relationship between hepatotoxicity during tuberculosis therapy and risk factors is an important issue to clinicians.
Patients who had prescribed with anti-tuberculosis medications from July 2001 through July 2002 at Taipei Municipal Wan-Fang Hospital were enrolled in present study. The medical charts of patients in enrollment group were retrospectively reviewed.
245 patients with a high percentage (122, 48.9%) of patients developed hepatotoxicity in present study. Among patients developed hepatotoxicity, 81 (33.1%) had abnormal liver function and 41 (16.7%) had liver injury.
Through data colletion from clinical cases, male, age older than 35 years old, concommitant more than 2 other diseases, hypertension, asthma, COPD, GI-related disease, smoking, severe drinking, cocurrent use of other hepatotoxic medications, multiple medication use, abnormal baseline liver function test in AST and ALP were the idependent risk factors related to hepatotoxicity.
Using significant risk factors found in present study, a risk score draft were constructed to predict hepatotoxicity during antituberculosis therapy. Then use three-fold validation to train and test the internal validity of the score through independent variable variation. After repeatly validation, the best score composed of 9 risk factors was found, named Tuberculosis Therapy Hepatotoxicity Scale, with the average accuracy rate of 78.5% for hepatotoxicity group and average accuracy rate of 63.2 % for all.
By using of the risk score developed in present study, clinicians could evaluate patients quickly and easier before prescribing medications to improve monitoring in patients who would develop hepatotoxicity during their tuberculosis therapy.