不同护肝药物护佑抗痨治疗防治药物性肝损伤发生研究*

doi:10.3969/j.issn.1672-5069.2023.03.021

摘要/Abstract

摘要： 目的探讨联合应用护肝药物护佑抗痨治疗,以降低药物性肝损伤(DILI)的发生。方法 2015年3月～2022年3月我院诊治的结核性胸膜炎或/和肺结核患者324例,被分成A组80例、B组81例、C组80例和D组83例,在行标准抗痨治疗的同时,分别给予水飞蓟宾、复方甘草酸、多烯磷脂酰胆碱或未给予护肝药物治疗至6个月抗痨结束。采用ELISA法检测血清白细胞介素-2(IL-2)、IL-10和肿瘤坏死因子-α(TNF-ɑ)水平。结果 A组、B组和C组DILI发生率分别为22.5%、27.2%和21.3%,均显著低于对照组的45.8%(P<0.05);4组DILI患者肝功能指标峰值水平无显著性差异(P>0.05),在6个月抗痨结束时,A组血清ALT、AST和TBIL水平分别为(43.3±5.1)U/L、(36.9±5.0)U/L和(22.1±4.6)μmol/L,B组分别为(54.3±5.3)U/L、(37.5±4.5)U/L和(13.5±4.4)μmol/L,C组分别为(39.1±5.5)U/L、(34.6±4.1)U/L和(18.6±4.4)μmol/L,均显著低于D组【分别为(99.0±5.4)U/L、(146.5±14.8)U/L和(54.3±4.4)μmol/L,P<0.05】;4组DILI患者血清细胞因子峰值水平无显著性差异(P>0.05),在抗痨治疗结束时,A组血清IL-2和IL-10水平分别为(149.3±3.0)ng/L和(50.1±5.7)ng/mL,B组分别为(146.3±3.1)ng/L和(27.3±4.4)ng/mL,C组分别为(143.2±3.5)ng/L和(82.9±5.9)ng/mL,均显著高于对照组【分别为(72.6±3.7)ng/L和(25.3±5.1)ng/mL,而A组、B组和C组血清TNF-α水平分别为(2.2±0.5)ng/mL、(2.3±0.4)ng/mL和(2.3±0.4)ng/mL,均显著低于D组【(13.0±0.5)ng/mL,P<0.05】。结论在抗痨治疗的同时,选择合适的护肝药物口服,可以降低DILI的发生,也可以降低肝损伤程度,对保证抗结核治疗的顺利进行非常重要。

关键词: 药物性肝损伤, 结核病, 复方甘草酸苷, 水飞蓟宾, 多烯磷脂酰胆碱, 防治

Abstract: Objective The aim of this study was to investigate the preventive efficacy of liver-protecting medicines on the incidence of drug-induced liver injury (DILI). Methods A total of 324 patients with tubercular pleurisy and/or pulmonary tuberculosis were encountered in our hospital between March 2015 and March 2022, and all received standardized six-month anti-tubercular therapy. Simultaneously, the patients were randomly divided into group A (n=80), group B (n=81), group C (n=80) and group D (n=83), receiving oral silibinin, compound glycyrrhizin, polyene phosphatidyl choline and no liver-protecting medicine administration, respectively, until the discontinuation of anti-tubercular therapy. Serum interleukin-2 (IL-2), IL-10 and tumor necrosis factor-ɑ (TNF-ɑ) levels were detected by ELISA. Results The incidences of DILI in group A, group B, group C were 22.5%, 27.2% and 21.3%, all significantly lower than 45.8%(P<0.05) in group D; serum peak levels of biochemical parameters in the four groups with DILI were not significantly different (P>0.05), while at the end of six-month anti-tubercular therapy, serum ALT, AST and bilirubin levels in group A were (43.3±5.1)U/L, (36.9±5.0)U/L and (22.1±4.6)μmol/L, in group B were (54.3±5.3)U/L, (37.5±4.5)U/L and (13.5±4.4)μmol/L, and in group C were (39.1±5.5)U/L,(34.6±4.1)U/L and (18.6±4.4)μmol/L, all significantly lower than [(99.0±5.4)U/L, (146.5±14.8)U/L and (54.3±4.4)μmol/L, respectively, P<0.05] in group D; there were no significant differences respect to serum peak cytokine levels in the four groups(P>0.05); at the end of anti-tubercular therapy, serum IL-2 and IL-10 in group A were (149.3±3.0)ng/L and (50.1±5.7)ng/mL, in group B were (146.3±3.1)ng/L and (27.3±4.4)ng/mL, and in group C were (143.2±3.5)ng/L and (82.9±5.9)ng/mL, all significantly higher than [(72.6±3.7)ng/L and (25.3±5.1)ng/mL, while serum TNF-α levels in group A, B and C were (2.2±0.5)ng/mL, (2.3±0.4)ng/mL and (2.3±0.4)ng/mL, all significantly lower than [(13.0±0.5)ng/mL, P<0.05] in group D. Conclusion The application of liver-protecting medicines could remarkably reduce the incidence of DILI, relieve liver injuries, which might guarantee the anti-tubercular therapy going.

Key words: Drug-induced liver injury, Tuberculosis, Silibinin, Compound glycyrrhizin, Polyene phosphatidyl choline, Prevention

杨开宁, 王梦梦, 陈秀秀, 王占坤, 董紫薇. 不同护肝药物护佑抗痨治疗防治药物性肝损伤发生研究^*[J]. 实用肝脏病杂志, 2023, 26(3): 384-387.

Yang Kaining, Wang Mengmeng, Chen Xiuxiu et al.. Decreased incidences of drug-induced liver injury in patients with tubercular pleurisy and/or pulmonary tuberculosis during anti-tubercular therapy[J]. Journal of Practical Hepatology, 2023, 26(3): 384-387.

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不同护肝药物护佑抗痨治疗防治药物性肝损伤发生研究^*

Decreased incidences of drug-induced liver injury in patients with tubercular pleurisy and/or pulmonary tuberculosis during anti-tubercular therapy

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