接受雷公藤制剂治疗的类风湿性关节炎并发药物性肝损害患者临床特征及预后分析*

doi:10.3969/j.issn.1672-5069.2024.05.022

实用肝脏病杂志 ›› 2024, Vol. 27 ›› Issue (5): 733-736.doi: 10.3969/j.issn.1672-5069.2024.05.022

接受雷公藤制剂治疗的类风湿性关节炎并发药物性肝损害患者临床特征及预后分析^*

王娟, 郑自通, 刘丽华, 何鑫, 姚旭, 彭灿

410000 长沙市第三医院药学部(王娟,刘丽华,何鑫);门诊办公室(彭灿);南华大学附属第二医院药学部(郑自通);衡阳医学院药物药理研究所(姚旭)

收稿日期:2024-06-03 出版日期:2024-09-10 发布日期:2024-09-09
通讯作者: 彭灿,E-mail:3051426042@qq.com
作者简介:王娟,女,41岁,药理学硕士,副主任药师。研究方向:临床药学与药理学。E-mail:juanjuan19830803@163.com
基金资助:
^*湖南省自然科学基金资助项目(编号:2021JJ80015);长沙市科技计划项目(编号:kzd2401045)

Clinical feature of rheumatoid arthritis patients with drug-induced liver injury after tripterygium wilfordii preparation treatment

Wang Juan, Zheng Zitong, Liu Lihua, et al

Department of Pharmacy, Third Hospital, Changsha 410000, Hunan Province, China

Received:2024-06-03 Online:2024-09-10 Published:2024-09-09

摘要/Abstract

摘要： 目的分析总结接受雷公藤制剂治疗的类风湿性关节炎(RA)并发药物性肝损害(DILI)患者临床特征及预后情况。方法 2019年1月～2023年10月我院收治的60例RA并发DILI患者,均有应用雷公藤制剂治疗,经RUCAM量表评分诊断。结果在60例患者中,年龄大于46岁者占75.0%,应用雷公藤制剂超过4个月者占比为40.0%;RUCAM量表评分大于5分者占比为88.3%,肝细胞损伤型占比为66.7%,肝损伤1/2级占比为50.0%;治疗RA用药为雷公藤制剂(A组)、雷公藤制剂联合糖皮质激素(B组)、雷公藤制剂联合非甾体类抗炎药(C组)和雷公藤制剂联合糖皮质激素和非甾体类抗炎药(D组)分别为10例、12例、30例和8例,D组血生化指标相对高于其他各组(P<0.05);经临床护肝治疗7～75d,平均(23.4±7.0)d,治愈率为43.3%,临床好转率为50.0%,肝功能指标未恢复率为6.7%。结论 RA患者应用含雷公藤制剂方案治疗可能容易引起肝损伤,用药越多,肝损伤可能更明显,但大多预后良好。

关键词: 药物性肝损害, 类风湿性关节炎, 雷公藤制剂, 临床特征

Abstract: Objective This study was to investigate clinical features of rheumatoid arthritis (RA) patients with complicated drug-induced liver injury (DILI) after administration of herbal medicine, tripterygium wilfordii preparation trerament. Methods Sixty patients with RA and DILI were encountered in our hospital between January 2019 and October 2023, all had received treatment regimen containing tripterygium wilfordii preparation, and DILI was diagnosed by the Roussel Uclaf Causality Assessment Method (RUCAM). Results Of the 60 patients with RA and DILI, older than 46 years accounted for 75.0%, and longer than 4 months of tripterygium wilfordii preparation administration accounted for 40.0%; percentage of greater than five points of RUCAM score accounted for 88.3%, hepatocyte injury type accounted for 66.7%, and 1/2 grade of liver injuries accounted for 50.0%; the regimen for RA treatment included tripterygium wilfordii preparation(group A),tripterygium wilfordii preparation and steroids (group B),tripterygium wilfordii preparation and nonsteroidal anti-inflammatory agents (group C) and tripterygium wilfordii preparation, steroids and nonsteroidal anti-inflammatory agent combination (group D) in 10 cases, 12 cases, 30 cases and 8 cases, blood biochemical parameters in group D were significantly higher than those in other three groups (P<0.05); 26 patients (43.3%) recovered, 30 patients (50.0%)improved, and 4 (6.7%)discharged without liver function test normal after (23.4±7.0)day liver-protecting treatment. Conclusion Patients with rheumatoid arthritis are susceptible to liver injury after treatment of regimens containing tripterygium wilfordii preparation, the liver injuries might be even severe when too many drug combination administered, and fortunately, the prognosis is good.

Key words: Drug-induced liver injury, Rheumatoid arthritis, Herbal medicine, tripterygium wilfordii preparation, Clinical features

王娟, 郑自通, 刘丽华, 何鑫, 姚旭, 彭灿. 接受雷公藤制剂治疗的类风湿性关节炎并发药物性肝损害患者临床特征及预后分析^*[J]. 实用肝脏病杂志, 2024, 27(5): 733-736.

Wang Juan, Zheng Zitong, Liu Lihua, et al. Clinical feature of rheumatoid arthritis patients with drug-induced liver injury after tripterygium wilfordii preparation treatment[J]. Journal of Practical Hepatology, 2024, 27(5): 733-736.

参考文献

[1] 常岑, 张润润, 时一鸣, 等. 中医疗法治疗类风湿性关节炎的研究进展. 中国中药杂志, 2023, 48(2): 329-335.
[2] Cramp F. The role of non-pharmacological interventions in the management of rheumatoid-arthritis-related fatigue. Rheumatology (Oxford), 2019, 58(5):22-28.
[3] Wu CY, Yang HY, Lai JH. Anti-citrullinated protein antibodies in patients with rheumatoid arthritis: biological effects and mechanisms of immunopathogenesis. Int J Mol Sci, 2020, 21(11): 4015.
[4] Lu H, Yao Y, Yang J, et al. Microbiome-mirna interactions in the progress from undifferentiated arthritis to rheumatoid arthritis: evidence, hypotheses, and opportunities. Rheumatol Int, 2021, 41(9): 1567-1575.
[5] Fazeli MS, Khaychuk V, Wittstock K, et al. Rheumatoid arthritis-associated interstitial lung disease: epidemiology, risk/prognosticfactors, and treatment landscape. Clin Exp Rheumatol, 2021, 39(5): 1108-1118.
[6] 姜泉. 国际中医临床实践指南类风湿关节炎(2019-10-11). 世界中医药, 2020, 15(20): 3160-3168.
[7] 郭立杰, 王超, 王晓静, 等. 非甾体类抗炎药所致肝损伤的临床病理分析. 药物不良反应杂志, 2020, 22(2): 62-68.
[8] 赖荣陶, 陈成伟, 阳文新, 等. 药物性肝损伤因果关系评估量表:RECAM将取代RUCAM?肝脏, 2022, 27(7): 725-729.
[9] Tanaka Y. Recent progress in treatments of rheumatoid arthritis: an overview of developments in biologics and small molecules, and remaining unmet needs. Rheumatology (Oxford), 2021, 60(6): 12-20.
[10] Costello R, David T, Jani M.Impact of adverse events associated with medications in the treatment and prevention of rheumatoid arthritis. Clin Ther, 2019, 41(7): 1376-1396.
[11] Allison R, Guraka A, Shawa IT, et al.Drug induced liver injury - a 2023 update.J Toxicol Environ Health B Crit Rev, 2023,26(8):442-467.
[12] Aletaha D, Smolen JS. Does triple conventional synthetic disease-modifying antirheumatic drug therapy improve upon methotrexate as the initial treatment of choice for a rheumatoid arthritis patient? Rheum Dis Clin North Am, 2019, 45(3): 315-324.
[13] Qindeel M, Ullah MH, Fakhar-Ud-Din, et al. Recent trends, challenges and future outlook of transdermal drug delivery systems for rheumatoid arthritis therapy. J Control Release, 2020, 327: 595-615.
[14] Gautam S, Tolahunase M, Kumar U, et al. Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active rheumatoid arthritis patients: a randomized controlled trial. Restor Neurol Neurosci, 2019, 37(1): 41-59.
[15] Īlgün G, Şahin B. Serial multiple mediation of treatment adherence and disease activity in the relationship between continuity of care and health outcomes among rheumatoid arthritis patients. Int J Health Plann Manage, 2022, 37(6): 3075-3088.
[16] Wang F, Tang J, Li Z, et al. Oral methotrexate at doses 15-25 mg/week is non-inferior to parenteral regarding efficacy and safety in the treatment of rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol, 2022, 41(9): 2701-2712.
[17] Trouvin AP, Curis E, Nicolis I, et al. Experience of pain is correlated to treatment profile in patients with rheumatoid arthritis, differentiating 5 clusters of patients in a national cohort of 1100 women with rheumatoid arthritis. Joint Bone Spine, 2020, 87(6): 675-676.
[18] Ramírez J, Cuervo A, Celis R, et al. Biomarkers for treatment change and radiographic progression in patients with rheumatoid arthritis in remission: a 5 year follow-up study. Rheumatology (Oxford), 2021, 60(2): 667-674.
[19] Song D, Zhu X, Wang F, et al. Longitudinal monitor of jun N-terminal kinase pathway associated phosphatase reflects clinical efficacy to triple conventional disease-modifying anti-rheumatic drugs treatment in rheumatoid arthritis patients. Inflammopharmacology, 2021, 29(4): 1131-1138.
[20] 陈瑾, 刘传鑫, 杨培, 等. 基于系统药理学的雷公藤配伍甘草治疗类风湿性关节炎作用机制研究. 药物评价研究, 2019, 42(9): 1705-1722.

接受雷公藤制剂治疗的类风湿性关节炎并发药物性肝损害患者临床特征及预后分析^*

Clinical feature of rheumatoid arthritis patients with drug-induced liver injury after tripterygium wilfordii preparation treatment

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