伏立康唑导致的药物性肝损伤特征:基于CYP2C19基因代谢类型防治效果观察

doi:10.3969/j.issn.1672-5069.2025.06.018

Abstract

Abstract: Objective The aim of this study was to investigate prevention of drug-induced liver injury (DILI) based on CYP2C19 gene polymorphism in patients with fungal disease of lung (FDL) undergoing voriconazole therapy. Methods 96 patients with FDL were admitted to our hospital between March 2022 and March 2025, and were randomly divided into group A, group B and group C, with 32 cases in each group. CYP2C19 gene polymorphism was detected by PCR-gene chip. All patients received voriconazole antifungal treatment, and simultaneously, no hepatoprotective medicine was given in group A, silybin glucoside was given in group B, and in group C, no hepatoprotective medicine was given in 11 patients with CYP2C19-proven rapid metabolizers, silybin glucoside was given in 11 patients with CYP2C19-proven intermediate metabolizers, and silybin glucoside and phosphatidylcholine capsules were given in 10 patients with chronic metabolizers. Serum liver function tests and high-sensitivity C-reactive protein (hs-CRP) levels and serum interleukin-6 (IL-6) levels were detected routinely, and serum superoxide dismutase (SOD) and malondialdehyde (MDA) levels were detected by using visible spectrophotometry. Results By end of 6 week-treatment, the effective rates of antifungal treatment in group A, group B and group C were 78.1%, 75.0% and 84.4%(P＞0.05); the incidences of DILI in group A, B and C were 21.9%, 6.3% and 3.1%(P＜0.05); serum ALT, AST and bilirubin levels in group B and C were much lower than in group A, and serum ALT and AST level in patients with chronic metabolizers were much lower than in group B(P＜0.05); serum hs-CRP, IL-6 and MDA levels in group B and C were much lower than in group A, and serum MDA level in patients with chronic metabolizers was much lower than in group B (P＜0.05). Conclusion During voriconazole therapy in patients with FDL, a targeted preventive hepatoprotective treatment based on CYP2C19 gene metabolic type could precisely improve liver functions, which might finish anti-fungal treatment relatively safely.

Key words: Drug-induced liver injury, Fungal disease of the lung, Voriconazole, CYP2C19 gene polymorphism, Prophylaxis

Cheng Xi, Yang Xiaokang, Li Yao, et al. Prevention of drug-induced liver injury based on CYP2C19 gene polymorphism in patients with fungal disease of lung undergoing voriconazole therapy[J]. Journal of Practical Hepatology, 2025, 28(6): 870-873.

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Prevention of drug-induced liver injury based on CYP2C19 gene polymorphism in patients with fungal disease of lung undergoing voriconazole therapy

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