纠正低蛋白血症减少抗结核药物性肝损伤发生临床研究*

doi:10.3969/j.issn.1672-5069.2022.06.009

摘要/Abstract

摘要： 目的探讨纠正低蛋白血症对减少抗结核药物性肝损伤(DILI)发生的作用。方法 2019 年3月～2021 年3 月汕头市中心医院感染病科收治的56例肺结核合并低蛋白血症患者被分为两组,每组28例。给予两组2HRZE/4HR抗结核治疗,另给予观察组输注人血白蛋白纠正低蛋白血症,对照组仅接受抗结核治疗,两组治疗时间均为6个月。使用全自动生化分析仪检测血清白蛋白(ALB)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、碱性磷酸酶(ALP)和总胆红素(TBIL)水平,采用化学发光法检测血清总胆汁酸(TBA)水平。在DILI发生时,给予护肝治疗。在治疗结束时,评定临床转归,进行痰培养和肺部CT检查。结果观察组结核治愈有效率为92.9%,显著高于对照组的71.4%(P<0.05);观察组痰菌转阴率为91.3%,显著高于对照组的(66.7%,P<0.05),肺部病变吸收率为89.3%,显著高于对照组的64.3%(P<0.05);在治疗期间,观察组DILI发生率为25.0%,显著低于对照组的53.6%(P<0.05);在DILI发生时,7例观察组血清ALB水平为(35.2±4.9)g/L,显著高,15例对照组【(29.6±4.9)g/L g/L,P<0.05】,而血清TBIL水平为(33.6±5.2)μmol/L,显著低于对照组【(45.7±16.6)μmol/L,P<0.05】;在护肝治疗后,观察组血清AST、ALT、ALP、TBIL和TBA水平分别为(39.4±9.8)U/L、(35.1±10.8)U/L、(98.6±16.2)U/L、(17.4±4.6)μmol/L和(81.3±13.7)μmol/L,均显著低于对照组【分别为(64.8±9.9)U/L、(78.0±13.8)U/L、(133.7±22.9)U/L、(26.5±6.8)μmol/L和(96.9±16.4)μmol/L,P<0.05】。结论补充人血白蛋白及时纠正低蛋白血症,对于肺结核合并低蛋白血症患者能够提高结核治愈率,降低药物性肝损害发生率,值得进一步研究。

关键词: 药物性肝损伤, 肺结核, 低蛋白血症, 抗结核药物, 人血白蛋白, 治疗

Abstract: Objective The aim of this study was to explore the supplement of human blood albumin products in reducing the incidence of drug-induced liver injury (DILI) in patients with pulmonary tuberculosis ans hypoproteinemia. Methods 56 patients with pulmonary tuberculosis and hypoproteinemia were encountered in the Department of Infectious Diseases, Shantou Central Hospital between March 2019 and March 2021, and were divided into control (n=28) and observation (n=28) groups. All patients were treated with the anti-tuberculosis regimen, e.g. 2HRZE/4HR, and those in the observation group was additionally given human blood albumin product infusion. The anti-tuberculosis treatment lasted for six months, and the patients with DILI received liver-protecting medicine appropriately. Serum albumin (ALB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TBIL) levels were detected by fully automated biochemical Analyzer, and serum total bile acid (TBA) level was detected by chemiluminescence. The clinical outcomes were evaluated by CT scan and sputum specimen culture and the incidence of DILI was recorded. Results The total effective rate in the observation group was 92.9%, significantly higher than 71.4% (P<0.05) in the control group; the negative rate of sputum bacteria in the observation group was 91.3%, significantly higher than 66.7% (P<0.05) and the absorption of lung lesions was 89.3%, significantly higher than 64.3%(P<0.05) in the control; during the period of anti-tuberculosis, the incidence of DILI in the observation group was 25.0%, significantly lower than 53.6%(P<0.05) in the control; when the DILI occurred, serum ALB level in the 7 patients in the observation group was (35.2±4.9)g/L, significantly higher than [(29.6±4.9)g/L, P<0.05], while serum bilirubin level was (33.6±5.2)μmol/L, significantly lower than [(45.7±16.6)μmol/L, P<0.05] in 15 patients in the control; after the liver-protecting treatment, serum AST, ALT, ALP, TBIL and TBA levels in the observation were (39.4±9.8)U/L, (35.1±10.8)U/L, (98.6±16.2)U/L, (17.4±4.6)μmol/L and (81.3±13.7)μmol/L, all significantly lower than [(64.8±9.9)U/L, (78.0±13.8)U/L, (133.7±22.9)U/L, (26.5±6.8)μmol/L and (96.9±16.4)μmol/L, respectively, P<0.05] in the control. Conclusion Our observation suggest that the infusion of human blood albumin product in time to correct hypoalbuminemia in patients with pulmonary tuberculosis could reduce the incidence of DILI, and improve the recovery of tuberculosis.

Key words: Drug-induced liver injury, Pulmonary tuberculosis, Hypoproteinemia, Anti-tuberculous medicines, Human blood albumin products, Therapy

赵资德, 吴令杰, 张海生, 陈瑞烈. 纠正低蛋白血症减少抗结核药物性肝损伤发生临床研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 792-795.

Zhao Zide, Wu Lingjie, Zhang Haisheng, et al.. Could the supplement of human blood albumin product reduce the incidence of drug-induced liver injury in patients with pulmonary tuberculosis and hypoproteinemia?[J]. Journal of Practical Hepatology, 2022, 25(6): 792-795.

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纠正低蛋白血症减少抗结核药物性肝损伤发生临床研究^*

Could the supplement of human blood albumin product reduce the incidence of drug-induced liver injury in patients with pulmonary tuberculosis and hypoproteinemia?

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