摘要
目的观察应用N-乙酰半胱氨酸(NAC)联合双环醇治疗抗结核药物所致的药物性肝损伤(DILI)患者的疗效。方法2018年1月~2020年1月我院诊治的因肺结核接受抗结核药物治疗导致的DILI患者76例,随机分为A组38例和B组38例,分别给予双环醇或双环醇联合NAC治疗,两组均连续治疗1个月或至肝功能正常。因本组患者被发现得早,肝功能损害较轻,未停止抗结核治疗。采用黄嘌呤氧化法和硫代巴比妥酸法检测血清超氧化物歧化酶(SOD)和丙二醛(MDA)水平,采用双抗体夹心ELISA法检测血清白细胞介素-6(IL-6)水平,采用免疫散射速率比浊法检测血清C-反应蛋白(CRP)水平。结果在治疗结束时,B组血清AST、ALT和GGT水平分别为(39.3±10.5)U/L、(35.9±32.5)U/L和(58.4±10.5)U/L,显著低于A组【分别为(75.4±14.6)U/L、(86.9±44.8)U/L和(95.8±14.5)U/L,P<0.05】;B组血清SOD水平为(83.5±8.0)U/L,显著高于A组【(74.5±7.3)U/L,P<0.05】,而血清MDA、IL-6和CRP水平分别为(5.0±0.8)μmol/L、(4.1±1.2)ng/L和(9.1±2.2)mg/L,显著低于A组【分别为(6.9±1.2)μmol/L、(6.8±2.4)ng/L和(14.5±3.7)mg/L,P<0.05】;在治疗过程中,B组与A组出现头晕、腹泻、皮疹、发热和恶性呕吐发生率无显著性差异(18.4%对15.8%,P>0.05)。结论应用NAC联合双环醇治疗抗结核药物所致的DILI患者可获得较好的治疗效果,能促进血清肝功能指标的恢复,可能与抑制了机体氧化应激和炎症反应有关,同时患者加用药物后也未明显增加用不良反应发生率,但其长期治疗效果还需要进一步观察。
Objective This study aimed to investigate the efficacy of N-acetylcysteine(NAC)and dicyclol combination in the treatment of patients with antituberculous drugs-induced liver injury(DILI).Methods Seventy-six patients with DILI caused by anti-tuberculocidal agents for pulmonary tuberculosis were enrolled in our hospital between January 2018 and January 2020,and were randomly divided into group A and group B,with 38 cases in each group.All patients received symptomatic supporting treatment and nutritional supplement without discontinuing antituberculosis medication.The patients in group A were treated with bicyclol,and those in group B received bicyclol and NAC combination therapy for one month or didn’t stop until serum liver function tests recovered.Serum aspartate aminotransferase(AST),alanine aminotransferase(ALT),total bilirubin(TBIL),gamma glutamine transferase(GGT),superoxide dismutase(SOD),malondialdehyde(MDA),interleukin-6(IL-6)and C-reactive protein(CRP)levels were detected.Results At the end of treatment,serum AST,ALT and GGT levels in group B were(39.3±10.5)U/L,(35.9±32.5)U/L and(58.4±10.5)U/L,significantly lower than[(75.4±14.6)U/L,(86.9±44.8)U/L and(95.8±14.5)U/L,respectively,P<0.05]in group A;serum SOD level was(83.5±8.0)U/L,significantly higher than[(74.5±7.3)U/L,P<0.05],while serum MDA,IL-6 and CRP levels were(5.0±0.8)μmol/L,(4.1±1.2)ng/L and(9.1±2.2)mg/L,all significantly lower than[(6.9±1.2)μmol/L,(6.8±2.4)ng/L and(14.5±3.7)mg/L,respectively,P<0.05]in group A;the complications such as dizziness,diarrhea,rash,fever,and nausea and vomiting in the two groups were not significantly different(18.4%vs.15.8%,P>0.05).Conclusion The administration of bicyclol and NAC combination in treatment of patients with DILI caused by anti-tuberculosis agents could achieve a good curing efficacy with improved recovery of liver function index,which might be related to the inhibition of oxidative stress and inflammatory reactions.The long-term efficacy still needs further observation.
作者
杜云飞
刘景瑞
叶飞翔
Du Yunfei;Liu Jingrui;Ye Feixiang(Department of Pharmacy,Fourth People's Hospital,Huai’an 223000,Jiangsu Province,China)
出处
《实用肝脏病杂志》
CAS
2021年第6期847-850,共4页
Journal of Practical Hepatology
基金
国家自然科学基金面上项目(编号:81173073)。
