苦黄注射液预防抗结核药物导致的药物性肝损伤患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.01.015

Abstract

Abstract: Objective This study was to observe the Kuhuang, a herbal injection compound, in preventing anti-tuberculosis drugs (ATD)-induced liver injury(DILI) for avoiding unreasonable anti-tuberculosis treatment interruption. Methods A total of 97 patients with naïve pulmonary tuberculosis were encountered in our hospital between March 2022 and November 2022, and were randomly divided into control (n=47) and observation (n=50) groups, receiving standardized 2HREZ/4HR anti-tuberculosis therapy, or intravenous injection of Kuhuang compound at base of anti-tuberculosis for 8 weeks. Serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were detected by ELISA, and serum heme oxygenase (HO-1) and superoxide dismutase (SOD) levels were detected by radioimmunoassay. Results At the end of 4 week anti-tuberculosis treatment, the incidences of adaptive liver injury (ALI) and DILI in the observation group were 6.0% and 2.0%, much lower than 17.0% and 8.5%(P＜0.05) in the control, and at the end of 8 week treatment, the incidences of ALI and DILI were 6.0% and 4.0%, much lower than 21.3% and 17.0%(P＜0.05) in the control group; at the end of 8 week treatment, serum ALT, AST and total bilirubin levels in the observation group were (28.4±23.4)U/L, (30.8±18.7)U/L and (12.9±7.3)μmol/L, all significantly lower than [(53.1±33.1)U/L, (52.5±37.7)U/L and (20.1±10.9)μmol/L, respectively, P＜0.05] in the control; serum HO-1 and SOD levels were (200.3±14.0)U/L and (418.0±18.7)U/L, both significantly higher than [(128.8±21.4)U/L and (318.0±15.1)U/L, P＜0.05], while serum IL-6 and TNF-α levels were (11.4±1.9)ng/L and (9.3±1.8)ng/L, both significantly lower than [(17.5±4.0)ng/L and (14.5±3.0)ng/L, respectively, P＜0.05] in the control. Conclusion The administration of Kuhuang injection compound could prevent the occurrence of anti-tuberculosis DILI, and guarantee the standardized anti-tuberculosis treatment completing.

Key words: Drug-induced liver injury, Pulmonary tuberculosis, Antituberculosis medicines, Adaptation phenomenon, Kuhuang injection, herbal medicine, Prevention

Ren Hao, Liu Liwei, Shi Wei, et al. Administration of Kuhuang, a herbal injection compound, in preventing anti-tuberculosis drug-induced liver injury in patients with naïve pulmonary tuberculosis[J]. Journal of Practical Hepatology, 2024, 27(1): 56-59.

References

[1] Wang YS, Zhu WL, Li T, et al. Changes in newly notified cases and control of tuberculosis in China: time-series analysis of surveillance data. Infect Dis Poverty, 2021, 10:1-10.
[2] 杨松, 郭建琼, 严晓峰. 抗结核药物性肝损伤发生机制的研究进展. 中华结核和呼吸杂志, 2019, 42(5):378-381.
[3] 中华医学会消化病学分会肝胆疾病协作组.全国多中心急性药物性肝损伤住院病例调研分析.中华消化杂志,2007,27(7):439-442.
[4] 许建明,蔡轶.药物性肝损伤适应与耐受的认识与困惑. 中华肝脏病杂志,2012,20(3):148-181.
[5] Nagarajan S, Whitaker P. Management of adverse reactions to first-line tuberculosis antibiotics. Curr Opin Allergy Clin Immunol, 2018, 18(4): 333-341.
[6] Huo F, Lu J, Zong Z, et al. Change in prevalence and molecular characteristics of isoniazid-resistant tuberculosis over a 10-year period in China. BMC Infect Dis,2019, 19(1):689.
[7] Saukkonen JJ, Cohn DL, Jasmer RM, et al. Antituberculosis therapy subcommittee. an official ATS statement: hepatotoxicity of antitiberculosis therapy. Am J Respir Crit Care Med ,2006, 174(8):935-952.
[8] 中华医学会呼吸系统疾病基层诊疗指南编写专家组. 肺结核基层诊疗指南(2018年). 中华全科医师杂志, 2019, 18(8): 709-717.
[9] 中华医学会结核病学分会. 抗结核药所致药物性肝损伤诊断与处理专家建议. 中华结核和呼吸杂志, 2013, 36(10): 732-736.
[10] Rawat A, Chaturvedi S, Singh AK, et al. Metabolomics approach discriminates toxicity index of pyrazinamide and its metabolic products, pyrazinoic acid and 5-hydroxy pyrazinoic acid. Hum Exp Toxicol, 2018, 37(4):373-389.
[11] Cao J, Mi Y, Shi C, et al. First-line anti-tuberculosis drugs induce hepatotoxicity: a novel mechanism based on a urinary metabolomics platform. Biochem Biophys Res Commun, 2018, 497(2): 485-491.
[12] Elmorsy E, Attalla S M, Fikry E, et al. Adverse effects of antituberculosis drugs on HepG2 cell bioenergetics. Hum Exp Toxicol, 2017, 36(6): 616-625.
[13] Guo H L, Hassan H M, Ding P P, et al. Pyrazinamide-induced hepatotoxicity is alleviated by 4-PBA via inhibition of the PERK-eIF2α-ATF4-CHOP pathway. Toxicology, 2017, 378: 65-75.
[14] Zhang W, Chen L, Shen Y, et al. Rifampicin-induced injury in L02 cells is alleviated by 4-PBA via inhibition of the PERKATF4-CHOP pathway. Toxicol In Vitro, 2016, 36: 186-196.
[15] Usui T, Meng X, Saide K, et al. From the cover: characterization of isoniazid-specific T-cell clones in patients with anti-tuberculosis drug-related liver and skin injury. Toxicol Sci, 2017, 155(2): 420-431.
[16] Garcia-Cortes M, Robles-Diaz M, Stephens C, et al. Drug induced liver injury: an update. Arch Toxicol, 2020, 94(10):3381-3407.
[17] Shaw PJ, Ganey PE, Roth RA. Idiosyncratic drug-induced liver injury and the role of inflammatory stress with an emphasis on an animal model of trovafloxacin hepatotoxicity. Toxicol Sci,2010, 118(1):7-18.
[18] Roth RA, Maiuri AR, Ganey PE. Idiosyncratic drug-induced liver injury: is drug-cytokine interaction the linchpin? J Pharmacol Exp Ther,2017, 360(2):461-470.
[19] Wink S, Hiemstra SW, Huppelschoten S, et al. Dynamic imaging of adaptive stress response pathway activation for prediction of drug induced liver injury. Arch Toxicol,2018, 92(5):1797-1814.
[20] Kramar B, Pirc Marolt T, Monsalve M, et al. Antipsychotic drug aripiprazole protects liver cells from oxidative stress. Int J Mol Sci,2022, 23(15):8292.

Administration of Kuhuang, a herbal injection compound, in preventing anti-tuberculosis drug-induced liver injury in patients with naïve pulmonary tuberculosis

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