水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致药物性肝损伤患者疗效研究*

doi:10.3969/j.issn.1672-5069.2023.05.016

摘要/Abstract

摘要： 目的观察应用水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致药物性肝损伤(DILI)患者的疗效。方法 2018年6月～2021年6月我院收治的118例肺结核患者,经标准抗痨治疗后,发生DILI者63例,采用随机数字表法将其分为对照组30例和观察组33例,在继续抗痨的基础上,在对照组给予多烯磷脂酰胆碱治疗,在观察组给予多烯磷脂酰胆碱联合水飞蓟宾胶囊治疗,两组均护肝治疗至抗痨结束。采用ELISA法检测血清白介素2(IL-2)、IL-6、IL-1β和肿瘤坏死因子-α(TNF-α)水平,采用放射免疫法检测血清超氧化物歧化酶(SOD)水平,采用生化比色法检测血清还原型谷胱甘肽(GSH)和丙二醛(MDA)水平。结果在治疗后,观察组血清ALT、AST和GGT水平分别为(32.8±6.1)U/L、(41.2±8.3)U/L和(36.1±6.5)U/L,显著低于对照组【分别为(48.6±8.4)U/L、(53.8±9.2)U/L和(53.8±9.6)U/L,P<0.05】;观察组血清IL-6、IL-1β和TNF-α水平为(6.3±1.0)ng/L、(11.0±2.3)μg/L和(6.8±1.5)ng/L,均显著低于对照组【分别为(9.5±1.2)ng/L、(19.2±3.6)μg/L和(9.9±1.3)ng/L,P<0.05】,而两组血清IL-2水平无显著性差异(P>0.05);观察组血清SOD和GSH水平分别为(597.3±71.6)U/L和(7.6±1.5)μmol/L,显著高于对照组【分别为(542.8±68.2)U/L和(6.2±1.3)μmol/L,P<0.05】,而血清MDA水平为(4.0±0.7)nmol/L,显著低于对照组【(5.8±0.9)nmol/L,P<0.05】。结论应用水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致的DILI患者能很好地保护肝功能,维持抗痨治疗,可能与减轻了炎症和氧化应激反应有关。

关键词: 药物性肝损伤, 抗结核药物, 水飞蓟宾, 多烯磷脂酰胆碱, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury (DILI). Methods 118 patients with pulmonary tuberculosis were encountered in our hospital between June 2018 and June 2021, and all received standardized anti-tuberculosis treatment by 2HRS( E) Z /4HR for six months. During the process, 63 patients were found having DILI, and were randomly divided into control (n=30) and observation (n=33) groups, receiving polyene phosphatidylcholine or silibinin capsule and polyene phosphatidylcholine combination therapy until the anti-tuberculosis regimen ended. Serum interleukin-2 (IL-2), IL-6, IL-1β and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, serum superoxide dismutase (SOD) was detected by radioimmunoassay and serum reduced glutathione (GSH) and malondialdehyde (MDA) levels were assayed by biochemical colorimetry. Results After treatment, serum ALT, AST and GGT levels in the observation group were (32.8±6.1)U/L, (41.2±8.3)U/L and (36.1±6.5)U/L, all significantly lower than [(48.6±8.4)U/L, (53.8±9.2)U/L and (53.8±9.6)U/L, respectively, P<0.05] in the control; serum IL-6, IL-1β and TNF-α levels in the observation were (6.3±1.0)ng/L, (11.0±2.3)μg/L and (6.8±1.5)ng/L, all much lower than [(9.5±1.2)ng/L, (19.2±3.6)μg/L and (9.9±1.3)ng/L, respectively, P<0.05] in the control, while there was no significant difference respect to serum IL-2 levels in the two groups (P>0.05); serum SOD and GSH levels in the observation group were (597.3±71.6)U/L and(7.6±1.5)μmol/L, both significantly higher than [(542.8±68.2)U/L and (6.2±1.3)μmol/L, P<0.05], while serum MDA level was (4.0±0.7)nmol/L, much lower than [(5.8±0.9)nmol/L, P<0.05] in the control. Conclusion The administration of silibinin capsule and polyene phosphatidylcholine combination in treatment of patients with pulmonary tuberculosis during anti-tuberculosis therapy could protect the liver function test normal, and maintain the accomplishment of anti-tuberculosis treatment, which might be related to the relieving inflammation and oxidative stress response.

Key words: Drug-induced liver injury, Pulmonary tuberculosis, Anti-tuberculosis medicines, Silibinin, Polyene phosphatidylcholine, Therapy

莫俊俏, 林景, 羊莉. 水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致药物性肝损伤患者疗效研究^*[J]. 实用肝脏病杂志, 2023, 26(5): 666-669.

Mo Junqiao, Lin Jing, Yang Li. Improvement of liver function tests by silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury[J]. Journal of Practical Hepatology, 2023, 26(5): 666-669.

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水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致药物性肝损伤患者疗效研究^*

Improvement of liver function tests by silibinin and polyene phosphatidylcholine combination therapy in patients with anti-tuberculosis drugs-induced liver injury

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