还原型谷胱甘肽、甘草酸二铵和复方甘草酸苷治疗抗结核药物所致药物性肝损伤患者成本-效益分析  

Cost-effectiveness analysis of reduced glutathione,diammonium glycyrrhizinate and glycyrrhizin in the treatment of patients with anti-tuberculosis medicine-induced liver injury

作　　者：王俊红 戴玲[2] 陈国斌 杨路平 周晶 Wang Junhong;Dai Ling;Chen Guobin(Department of Gastroenterology,People's Hospital,Yingcheng 432400,Hubei Province,China)

机构地区：[1]湖北省应城市人民医院消化内科,432400 [2]湖北中医药大学附属湖北省中医院肝病科

出　　处：《实用肝脏病杂志》2023年第3期380-383,共4页Journal of Practical Hepatology

基　　金：湖北省卫生健康委科研项目(编号:WJ2019Q062)。

摘　　要：目的 探讨应用还原型谷胱甘肽、甘草酸二铵氯化钠和复方甘草酸苷注射液治疗抗结核药物所致的药物性肝损伤(DILI)患者的成本-效益。方法 2018年2月~2021年6月我院收治的93例抗结核药物所致的DILI患者被随机分为A组、B组和C组,每组31例,分别给予还原型谷胱甘肽注射液、甘草酸二铵氯化钠注射液或复方甘草酸苷注射液治疗4周。分别采用黄嘌呤氧化法、硫代巴比妥酸法和二硫基双硝基苯甲酸法检测血清超氧化物歧化酶(SOD)、丙二醛(MDA)和谷胱甘肽过氧化物酶(GSH-Px)水平,采用ELISA法检测血清白细胞介素-6(IL-6)、IL-1β和肿瘤坏死因子-α(TNF-α)水平。结果 在治疗4周结束时,三组血生化指标无显著性差异(P>0.05);A组血清SOD、MDA和GSH-Px水平分别为(79.1±10.2)U/L、(5.4±0.9)μmol/L和(112.3±14.6)U/L,与B组【分别为(78.3±7.9)U/L、(6.2±1.5)μmol/L和(106.8±17.1)U/L】或C组【分别为(77.7±11.4)U/L、(5.9±1.1)μmol/L和(109.6±12.9)U/L】比,无显著性差异(P>0.05);A组血清IL-6、TNF-α和IL-1β水平分别为(7.9±1.9)pg/mL、(8.2±1.9) pg/mL和(20.9±3.6)ng/mL,与B组【分别为(8.6±2.0)pg/mL、(9.3±2.1)pg/mL和(22.0±5.5)ng/mL】或C组【分别为(8.2±2.2)pg/mL、(8.8±1.6)pg/mL和(21.6±4.7)ng/mL】比,无显著性差异(P>0.05);还原型谷胱甘肽、甘草酸二铵氯化钠和复方甘草酸苷注射液治疗成本分别为617.4元、735.0元和718.2元,其C/E比分别为6.6、7.6和8.0,与成本最低的还原型谷胱甘肽注射液相比,甘草酸二铵氯化钠和复方甘草酸苷注射液每增加1个单位的总有效率,其费用分别增加35.6元和31.5元,其敏感度分析结果也未变。结论 应用还原型谷胱甘肽、甘草酸二铵氯化钠和复方甘草酸苷注射液治疗抗结核药物所致的DILI患者均有效,可能与减轻了氧化应激和炎性损伤有关,三者作用效果相当,而以还原型谷胱甘肽注射液成本-效益最优。Objective The aim of this study was to investigate the cost-effectiveness of reduced glutathione,diammonium glycyrrhizate and compound glycyrrhizin in the treatment of patients with anti-tuberculosis drug-induced liver injury(DILI).Methods A total of 93 patients with DILI caused by anti-tuberculosis agents were admitted to our hospital between February 2018 and June 2021,and were randomly divided into group A,group B and group C,with 31 cases in each,receiving reduced glutathione injection,diammonium glycyrrhizate sodium chloride injection and compound glycyrrhizin injection treatment for four weeks.Serum superoxide dismutase(SOD),malondialdehyde(MDA)and glutathione peroxidase(GSH-Px)levels were detected.Serum interleukin-6(IL-6),IL-1βand tumor necrosis factor-α(TNF-α)levels were assayed by ELISA.Results There was no significant difference as respect to the biochemical response rates in the three groups(P>0.05);serum SOD,MDA and GSH-Px levels in group A were(79.1±10.2)U/L,(5.4±0.9)μmol/L and(112.3±14.6)U/L,not significantly different as compared to[(78.3±7.9)U/L,(6.2±1.5)μmol/L and(106.8±17.1)U/L]in group B or[(77.7±11.4)U/L,(5.9±1.1)μmol/L and(109.6±12.9)U/L]in group C(P>0.05);serum IL-6,TNF-αand IL-1βlevels in group A were(7.9±1.9)pg/mL,(8.2±1.9)pg/mL and(20.9±3.6)ng/mL,not significantly different compared to[(8.6±2.0)pg/mL,(9.3±2.1)pg/mL and(22.0±5.5)ng/mL]in group B or[(8.2±2.2)pg/mL,(8.8±1.6)pg/mL and(21.6±4.7)ng/mL]in group C(P>0.05);the medical cost of reduced glutathione injection,diammonium glycyrrhizinate sodium chloride injection and compound glycyrrhizin injection were 617.4 yuan,735.0 yuan and 718.2 yuan,and their C/E ratio were 6.6,7.6 and 8.0,respectively;as compared with the lowest medical cost of reduced glutathione injection,the one point of increased total effective rate by diammonium glycyrrhizinate sodium chloride injection or compound glycyrrhizin injection had the increment of costs of 35.6 yuan and 31.5 yuan,respectively,and the similar results were found by sensi

关 键 词：药物性肝损伤 还原型谷胱甘肽 甘草酸二铵 复方甘草酸苷 治疗 成本-效益分析 

分 类 号：R956[医药卫生—药学]