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

作　　者：杨开宁 王梦梦 陈秀秀 王占坤 董紫薇 Yang Kaining;Wang Mengmeng;Chen Xiuxiu(Department of Pharmacy,Second Central Hospital,Baoding 072750,Hebei Province,China)

机构地区：[1]承德医学院附属保定市第二中心医院药剂科,河北省保定市072750

出　　处：《实用肝脏病杂志》2023年第3期384-387,共4页Journal of Practical Hepatology

基　　金：河北省卫生健康委医学科学研究重点项目(编号:20160280)。

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。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-αlevels 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 cou

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 

分 类 号：R575[医药卫生—消化系统]