摘要
目的 研究初治结核病患者预防使用保肝药物对抗结核药物引起的药物性肝损伤(drug-induced liver injury, DILI)的临床价值。方法 选取2015年12月—2017年12月我院收治226例出现DILI的初治肺结核,依据治疗方法不同,分为观察组( n =122)与对照组( n =104)。观察组予规范抗结核及预防性保肝药物治疗,对照组予规范抗结核治疗。两组发生DILI后均停用所有药物,并且予以相应治疗,直至DILI恢复正常1周后停药。检测治疗前、出现DILI时、治疗后肝功能相关指标变化,记录DILI分型、分级、发生时间及肝功能恢复正常时间,比较CD4+ T淋巴细胞计数及合并疾病。结果 与对照组比较,观察组出现DILI时总胆红素水平及治疗后碱性磷酸酶水平均下降,差异有统计学意义( P <0.05)。两组DILI分型比较差异无统计学意义( P >0.05);两组DILI分级仅1级损伤比较差异有统计学意义( P =0.004)。观察组、对照组发生3级及以上DILI的概率分别为9.02%(11/122)、18.27%(19/104),比较差异有统计学意义( P =0.04)。观察组DILI发生时间为8~75(17.40±13.43)d,对照组DILI发生时间为2~55(10.28±11.92)d,比较差异有统计学意义( P =0.008)。两组肝功能未完全恢复情况比较差异有统计学意义( P =0.002),但3级及以上DILI患者肝功能未完全恢复情况比较差异无统计学意义( P =0.85)。两组CD4+T淋巴细胞计数、发生3级及以上DILI患者CD4+T淋巴细胞计数比较差异均无统计学意义( P >0.05)。两组3级及以上DILI合并疾病比较差异无统计学意义( P =0.72)。结论 预防性给予保肝药物对初治结核病患者的肝功能无明显保护作用,但对部分具有肝损伤高危因素或免疫力低下的患者来说,预防性使用保肝药物对抗结核药物引起的DILI有一定益处。
Objective To study the clinical significance and value of hepatoprotective drugs in preventing drug-induced liver injury (DILI) in patients with newly-diagnosed tuberculosis. Methods From December 2015 to December 2017, 226 patients with newly-diagnosed pulmonary tuberculosis (PT) in our hospital were divided into observation group ( n =122) and control group ( n =104) according to different treatment methods. The observation group was given standardized anti-tuberculosis and liver protective therapy, and the control group was given standardized anti-tuberculosis treatment. All drugs were discontinued after development of DILI in both groups and they were treated accordingly until the DILI returned to normal for 1 week. The changes of indexes of liver function before treatment, when developing DILI and after treatment were detected. Classification, grading, and time of occurrence of liver injury, as well as recovery time of liver injury were recorded. CD4+ T lymphocyte count and combined disease were compared. Results Compared with the control group, the total bilirubin level when DILI occurred and alkaline phosphatase level after treatment in the observation group were decreased, and the difference was statistically significant ( P <0.05). There was no significant difference in DILI classification between the two groups ( P >0.05), however, significant differences were observed in grade 1 DILI ( P =0.004). The probability of DILI (grade ≥3) of the observation group and the control group were 9.02%(11/122) and 18.27%(19/104), respectively, with significant difference ( P =0.04). The occurrence time of DILI in the observation group was 8-75 (17.40±13.43) d, while that in the control group was 2-55 (10.28±11.92) d, with significant difference ( P =0.008). There was significant difference in the incomplete recovery of liver function between the two groups ( P =0.002), but there was no significant difference between DILI patients of grade ≥3 ( P =0.85). No significant difference was found in CD4+ T lymphocyte count between the two groups and CD4+T lymphocyte counts in patients with DILI of grade ≥3 ( P >0.05). There was no significant difference in the combined disease between the two groups with DILI of grade ≥ 3 ( P =0.72). Conclusion Preventive administration of hepatoprotective drugs has no significant protective effect on the liver function of newly-diagnosed tuberculosis patients, but for some patients with high risk factors of liver injury or low immunity, it is beneficial to use hepatoprotective drugs against DILI caused by tuberculosis drugs.
作者
王超
郭立杰
张海丛
王玉泽
杜婧
WANG Chao;GUO Li-jie;ZHANG Hai-cong;WANG Yu-ze;DU Jing(Department of Pharmacy, Shijiazhuang Fifth Hospital, Shijiazhuang 050021, China;Department of Clinical Laboratory, Shijiazhuang Fifth Hospital, Shijiazhuang 050021, China)
出处
《临床误诊误治》
2019年第9期21-26,共6页
Clinical Misdiagnosis & Mistherapy
基金
2017年度河北省医学科学研究重点课题计划(20171000)
2016年度河北省医学科学研究重点课题计划(20160787)
关键词
结核
肺
药物性肝损伤
抗结核药
肝脏保护
Tuberculosis, pulmonary
Drug-induced liver injury
Antitubercular agents
Liver protection
