基于倾向性评分匹配法探讨不同种数保肝药物联用对药物性肝损伤治疗效果差异  

Comparative effectiveness of different numbers of hepatoprotective drugs on druginduced liver injury based on propensity score matching

作　　者：李春杏 李云杉 刘丽艳 李妍[1] 蔡金蕊 朱元民 LI Chun-xing;LI Yun-shan;LIU Li-yan;LI Yan;CAI Jin-rui;ZHU Yuan-min(Department of Pharmacy,Aerospace Center Hospital,BEIJING 100049,China;Department of Evaluation,Aerospace Center Hospital,BEIJING 100049,China;Department of Gastroenterology,Aerospace Center Hospital,BEIJING 100049,China)

机构地区：[1]航天中心医院药剂科,北京100049 [2]航天中心医院评审评价处,北京100049 [3]航天中心医院消化科,北京100049

出　　处：《中国新药与临床杂志》2023年第5期317-322,共6页Chinese Journal of New Drugs and Clinical Remedies

基　　金：航天中心医院科研基金资助项目(YN202113)。

摘　　要：目的探讨不同种数保肝药物联用对药物性肝损伤(DILI)患者肝功能改善效果差异,旨在为临床合理使用保肝药物提供支持。方法回顾性分析本院2016年7月—2019年7月DILI成年患者保肝药物使用情况。将患者按照联用≥3种(观察组A)、联用1~2种(对照组A)、联用2种(观察组B)和单用1种保肝药物(对照组B)进行分组。根据患者年龄、性别、基线肝脏生物化学检查值进行11倾向性评分匹配。用药1周后,分别比较各观察组和对照组间肝功能改善效果及保肝药物费用的差异。结果纳入483例次DILI患者,中位年龄81(18,98)岁,联用1~5种保肝药物,其中45.8%联用≥3种,54.2%联用1~2种,30.4%联用2种,23.8%单用1种。用药1周后,各观察组和对照组间分别比较,丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)和总胆红素(TBIL)改变值均无显著差异(P>0.05)。观察组A保肝药物费用为对照组A的2.5~3倍,观察组B保肝药物费用为对照组B的2倍,比较具有显著差异(P<0.05)。结论联用≥3种保肝药物对肝功能短期治疗效果并不优于联用1~2种,联用2种保肝药物肝功能治疗效果与单用1种保肝药物相当,但保肝药物费用显著增加,不推荐DILI患者2种及以上保肝药物联用。AIM To explore the clinical efficacy treated with different number of hepatoprotective drugs in patients with drug-induced liver injury(DILI),in order to provide evidence support for rational use of hepatoprotective drugs in clinical practice.METHODS A retrospective analysis was performed on the use of hepatoprotective drugs in adult patients with DILI in our hospital from July 2016 to July 2019.The patients were divided into four groups according to numbers of hepatoprotective drugs:≥3(observation group A),1-2(control group A),2(observation group B)and 1(control group B).The patients in the two groups were matched by 1:1 based on propensity score matching according to age,sex and baseline liver biochemical test values.The clinical efficacy and cost of hepatoprotective drugs in the groups one week after treatment were compared.RESULTS A total of 483 cases with DILI,with a median age of 81(18,98)years.They were combined with 1-5 hepatoprotective drugs,45.8%used≥3 hepatoprotective drugs,54.2%used 1-2 hepatoprotective drugs,23.8%patients used only one hepatoprotective drugs.After one week of treatment,there were no significant differences in the change values of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,gamma-glutamyltransferase and total bilirubin between the observation groups and control group(P>0.05).The cost of hepatoprotective drugs in the observation group A was 2.5-3 times than in the control group A,and that in the observation group B was 2 times than in the control group B(P<0.05).CONCLUSION The short-term clinical efficacy of≥3 hepatoprotective drugs is not better than 1-2,the clinical efficacy of 2 hepatoprotective drugs is equivalent to that of 1 hepatoprotective drug,but the cost of hepatoprotective drugs increased significantly,so the combination of≥2 hepatoprotective drugs is not recommended for patients with DILI.

关 键 词：化学性与药物性肝损伤 倾向性评分 药物疗法 联合 保肝药物 疗效 

分 类 号：R975[医药卫生—药品]