关键词: 药物性肝损伤, 还原型谷胱甘肽, 甘草酸二铵, 复方甘草酸苷, 治疗, 成本-效益分析 ,  ,  

Abstract: Objective The aim of this study was to investigate the cost-effectiveness of reduced glutathione, diammonium glycyrrhizate and compound glycyrrhizin in the treatment of patients with anti-tuberculosis drug-induced liver injury (DILI). Methods A total of 93 patients with DILI caused by anti-tuberculosis agents were admitted to our hospital between February 2018 and June 2021,and were randomly divided into group A, group B and group C, with 31 cases in each, receiving reduced glutathione injection, diammonium glycyrrhizate sodium chloride injection and compound glycyrrhizin injection treatment for four weeks. Serum superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH-Px) levels were detected. Serum interleukin-6 (IL-6), IL-1β and tumor necrosis factor-α (TNF-α) levels were assayed by ELISA. Results There was no significant difference as respect to the biochemical response rates in the three groups(P＞0.05); serum SOD, MDA and GSH-Px levels in group A were (79.1±10.2)U/L, (5.4±0.9)μmol/L and (112.3±14.6) U/L, not significantly different as compared to [(78.3±7.9)U/L, (6.2±1.5)μmol/L and (106.8±17.1)U/L] in group B or [(77.7±11.4)U/L, (5.9±1.1)μmol/L and (109.6±12.9)U/L] in group C(P＞0.05); serum IL-6, TNF-α and IL-1β levels in group A were (7.9±1.9)pg/mL, (8.2±1.9) pg/mL and (20.9±3.6) ng/mL, not significantly different compared to [(8.6±2.0)pg/mL, (9.3±2.1) pg/mL and (22.0±5.5)ng/mL] in group B or [(8.2±2.2)pg/mL, (8.8±1.6)pg/mL and (21.6±4.7)ng/mL] in group C (P＞0.05); the medical cost of reduced glutathione injection, diammonium glycyrrhizinate sodium chloride injection and compound glycyrrhizin injection were 617.4 yuan, 735.0 yuan and 718.2 yuan, and their C/E ratio were 6.6, 7.6 and 8.0, respectively; as compared with the lowest medical cost of reduced glutathione injection, the one point of increased total effective rate by diammonium glycyrrhizinate sodium chloride injection or compound glycyrrhizin injection had the increment of costs of 35.6 yuan and 31.5 yuan, respectively, and the similar results were found by sensitivity analysis. Conclusion The application of reduced glutathione injection, diammonium glycyrrhizinate sodium chloride injection and compound glycyrrhizin injection in the treatment of patients with DILI caused by anti-tuberculosis medicines is all efficacious, which might inhibit oxidative stress and inflammatory injury, with the cost-effectiveness of reduced glutathione injection best.

Key words: Drug-induced liver injury, Reduced glutathione, Diammonium glycyrrhizinate, Compound glycyrrhizin, Therapy, Cost-effectiveness