异甘草酸镁联合还原型谷胱甘肽治疗化疗药物性肝损伤患者疗效及其血清氧化应激指标的变化研究*

doi:10.3969/j.issn.1672-5069.2025.02.016

摘要/Abstract

摘要： 目的探讨应用异甘草酸镁联合还原型谷胱甘肽治疗化疗药物性肝损伤(DILI)患者的疗效及其对血清氧化应激指标的影响。方法 2022年1月～2024年1月我院收治的146例化疗药物导致的DILI患者,被随机分为对照组73例和观察组73例,分别给予还原型谷胱甘肽或还原型谷胱甘肽联合异甘草酸镁治疗2～4w。采用微量法检测血清丙二醛(MDA)水平,采用邻苯三酚法检测血清超氧化物岐化酶(SOD)水平,采用速率法检测血清谷胱甘肽过氧化物酶(GSH-Px)水平。采用ELISA法检测血清肿瘤坏死因子α(TNF-α)、巨噬细胞移动抑制因子(MIF)、可溶性肿瘤坏死因子受体1(sTNFR1)和白细胞介素-10(IL-10)水平。结果在治疗结束时,观察组血清ALT、AST、ALP和GGT水平分别为(58.5±10.1)U/L、(53.7±4.3)U/L、(79.2±13.1)U/L和(56.1±5.9)U/L,均显著低于对照组【分别为(76.2±10.9)U/L、(71.5±6.6)U/L、(92.2±12.7)U/L和(71.9±6.3)U/L,P<0.05】;观察组血清MDA水平为(2.9±0.6)μmol/L,显著低于对照组【(5.6±0.7)μmol/L,P<0.05】,而血清SOD和GSH-Px水平分别为(96.5±7.1)U/L和(121.7±10.3)U/L,均显著高于对照组【分别为(80.6±7.5)U/L和(100.5±9.2)U/L,P<0.05】;观察组血清TNF-α和MIF水平分别为(3.8±0.5)ng/mL和(9.1±1.5)ng/mL,均显著低于对照组【分别为(7.6±1.7)ng/mL和(13.2±1.3)ng/mL,P<0.05】,而血清sTNFR1和IL-10水平分别为(3.1±0.5) pg/mL和(34.5±3.8)pg/mL,均显著高于对照组【分别为(1.5±0.4)pg/mL和(21.2±3.1)pg/mL,P<0.05】。结论应用异甘草酸镁联合还原型谷胱甘肽治疗化疗药物导致的DILI患者可以收到较好的临床疗效,可能与降低了机体氧化应激反应和改善了细胞因子代谢有关。

关键词: 药物性肝损伤, 异甘草酸镁, 还原型谷胱甘肽, 氧化应激, 治疗

Abstract: Objective The aim of this study was to investigate efficacy of magnesium isoglycyrrhizinate and reduced glutathione combination in treatment of patients with chemotherapeutic drug-induced liver injury (cDILI) and its impact on serum oxidative stress indexes. Methods 146 patients withcDILI were encountered in our hospital between January 2022 and January 2024, and were randomly divided into control (n=73) and observation (n=73) groups. Patients in the control group were treated with intravenous reduced glutathione, and those in the observation group were given intravenous magnesium isoglycyrrhizinate and reduced glutathione combination for two to four weeks. Serum malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels were assayed routinely. Serum tumor necrosis factor-α (TNF-α), macrophage migration inhibitory factor (MIF), soluble tumor necrosis factor receptor 1 (sTNFR1) and interleukin-10 (IL-10) levels were detected by ELISA. Results By the end of treatment, serum ALT,AST, ALPand GGT levels in the combination group were (58.5±10.1)U/L, (53.7±4.3)U/L, (79.2±13.1)U/L and (56.1±5.9)U/L, all significantly lower than [(76.2±10.9)U/L,(71.5±6.6)U/L, (92.2±12.7)U/Land (71.9±6.3)U/L, respectively, P<0.05] in the control; serum MDA level was (2.9±0.6)μmol/L, significantly lower than [(5.6±0.7)μmol/L, P<0.05], while serum SOD and GSH-Px levels were (96.5±7.1)U/L and (121.7±10.3)U/L, both significantly higher than [(80.6±7.5)U/Land (100.5±9.2)U/L, respectively, P<0.05] in the control; serum TNF-α and MIF levels in the combination group were (3.8±0.5)ng/mL and (9.1±1.5)ng/mL, both significantly lower than [(7.6±1.7)ng/mL and (13.2±1.3)ng/mL, respectively, P<0.05], while serum sTNFR1 and IL-10 levels were (3.1±0.5) pg/mL and (34.5±3.8)pg/mL, both significantly higher than [(1.5±0.4)pg/mL and (21.2±3.1)pg/mL, respectively, P<0.05] in the control. Conclusion Magnesium isoglycyrrhizinate and reduced glutathione combination in the treatment of patients with cDILI is efficacious, which might be related to reduction of body oxidative stress and modulation of cytokine metabolism. We hope that our experience could facilitate physicians to correctly identify DILI early in presentation and provide a choice of management.

Key words: Drug-induced liver injury, Magnesium isoglycyrrhizinate, Reduced glutathione, Oxidative stress, Therapy

孙超, 宋丽萍, 王彬. 异甘草酸镁联合还原型谷胱甘肽治疗化疗药物性肝损伤患者疗效及其血清氧化应激指标的变化研究^*[J]. 实用肝脏病杂志, 2025, 28(2): 222-225.

Sun Chao, Song Liping, Wang Bin. Efficacy of magnesium isoglycyrrhizinate and reduced glutathione combination in the treatment of patients with chemotherapeutic drug-induced liver injury and its influence on serum oxidative stress indexes[J]. Journal of Practical Hepatology, 2025, 28(2): 222-225.

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异甘草酸镁联合还原型谷胱甘肽治疗化疗药物性肝损伤患者疗效及其血清氧化应激指标的变化研究^*

Efficacy of magnesium isoglycyrrhizinate and reduced glutathione combination in the treatment of patients with chemotherapeutic drug-induced liver injury and its influence on serum oxidative stress indexes

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