抗氧化剂预防抗结核药物致肝损伤的随机开放研究  

A randomizd open clinical study of using antioxidants on the prevention of liver injury induced by anti-tuberculosis drugs

作　　者：覃红娟[1] 谭守勇[1] 邝浩斌[1] 吴迪 张宏[1] 汪敏[1] 叶锦泉[1] 袁圆[1] 冯治宇[1] 陈泽莹 李艳[1] QIN Hongjuan;TAN Shouyong;KUANG Haobin;WU Di;ZHANG Hong;WANG Min;YE Jinquan;YUAN Yuan;FENG Zhiyu;CHEN Zeying;LI yan(Guangzhou Chest Hospital,Guangzhou 510095,China)

机构地区：[1]广州市胸科医院结核内科

出　　处：《实用医学杂志》2019年第12期1867-1870,共4页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:粤科规划字【2013】137-114);广州市医药卫生科技项目(编号:20131A0011080);广州市医药卫生科技项目(编号:2015A011060004)

摘　　要：目的探讨N-乙酰半胱氨酸(NAC)预防抗结核药物肝损伤作用。方法肺结核患者196例,2HRZE/4HR+NAC(A组)及2HRZE/4HR+双环醇(B组)为观察组,2HRZE/4HR为对照组(C组),观察8周内肝损伤情况。结果(1)A组肝损伤率17.19%,停药率45.5%,低于C组22.73%,53.3%(P=0.691,P=0.430)。B组肝损伤率19.7%,低于C组22.73%(P=0.670),B组停药率76.9%,高于C组53.3%(P=0.778)。A组患者肝损伤率及停药率低于B组(P=0.712,P=0.245)。(2)发生肝损伤时间,A组多见于4~8周,B组多见2周内,C组3个时间段内相同。(3)各组转氨酶高值时间,A组(27.67±23.047)d较B组(19.75±16.080)d及C组(19.93±14.969)d迟。肝功能恢复时间,A组(16.83±9.998)d及C组(16.14±6.982)d较B组(22.10±19.319)d短,(P=0.469,P=0.478)。结论 NAC预防性护肝作用与双环醇相似,但减少治疗中断率及延迟肝损伤发生时间,肝功能恢复时间短。Objective To explore the role of anti-oxidant acetylcysteine(NAC)in prevention of liver injury induced by anti-tuberculosis drugs. Methods 196 patients were divided into three groups(2 HRZE/4 HR combined with NAC(A),2 HRZE/4 HR combined with bicyclol(B),and 2 HRZE/4 HR(C)and observed for 8 weeks.Results(1)In Group A,rate of incidences of liver injury was 17.19%,medication withdrawal 45.5%,lower than that in group C(22.73% and 53.3%,P = 0.430,P = 0.691). Rate of incidences of liver injury in Group B was 19.7%,lower than group C(22.73%,P = 0.670). Rate of incidences of medication withdrawal in Group B was 76.9%,higher than Group C(53.3%,P = 0.778). Rates of incidence of liver injury and medication withdrawal in group A were lower than Group B,(P = 0.712,P = 0.245).(2)Liver injury occurred in patients mostly in 4 ~8 weeks in Group A,mostly in 2 weeks in Group B,and equally in three time periods in Group C.(3)Transaminase of patients reached high level later in Group A(27.67 ± 23.047)day than Group B(19.75 ± 16.080)day and Group C(19.93 ± 14.969)day. It took shorter time for patients′ liver function to recover in group A(16.83 ±9.998)day and Group C(16.14 ± 6.982)day than that in Group B(22.10 ± 19.319)day. Conclusion Using antituberculosis while giving NAC can decrease the incidence of liver damage,delay the occurrence time of liver injury and reduce the interruption rate of treatment.

关 键 词：抗氧化剂 结核病 抗结核药物 肝损伤 预防 

分 类 号：R52[医药卫生—内科学] R575[医药卫生—临床医学]