异甘草酸镁治疗抗结核药物性肝损伤疗效

doi:10.3969/j.issn.1004-583X.2021.11.002

摘要/Abstract

摘要：

目的探讨异甘草酸镁(MgIG)治疗对抗结核药物引起肝损伤患者的疗效及细胞因子(IFN-γ, IL-10, TNF-α)的影响。方法选取2016年2月至2019年12月昆明医科大学第六附属医院感染科就诊的符合抗结核药物性肝损伤诊断标准的轻度肝细胞损伤型患者,随机分为观察组使用MgIG治疗(n=25)和对照组使用多烯磷脂酰胆碱治疗(n=25)。比较两组患者治疗前后肝功能(ALT, AST, TBIL)和细胞因子水平(IFN-γ, IL-10, TNF-α)变化。结果观察组患者治疗总有效率显著高于对照组患者(100% vs 76.0%, P<0.01)。两组患者IFN-γ、IL-10、TNF-α均较治疗前降低(P均<0.05);观察组IFN-γ, IL-10, TNF-α均低于对照组(P均<0.05)。Pearson相关分析显示,两组治疗前、治疗后的所有细胞因子水平与ALT呈正相关关系。结论在轻度的抗结核药物性肝损伤中,MgIG快速改善肝功能可能与其降低炎症细胞因子相关。

关键词: 化学性与药物性肝损伤, 抗结核药, 异甘草酸镁, 多烯磷脂酰胆碱, 细胞因子类

Abstract:

Objective To explore the efficacy of magnesium isoglycyrrhizinate(MgIG) in the treatment of anti-tuberculosis drug-induced liver injury (AT-DILI) and influence on cytokines (IFN-γ, IL-10, TNF-α).Methods The study enrolled 50 patients with mild hepatocellular injury who admitted to Infection Department, the Sixth Affiliated Hospital of Kunming Medical University from February 2016 to December 2019, and the patients met the criteria of AT-DILI. Patients were randomly grouped, 25 patients in observation group treated with MgIG, 25 patients in control group with polyene phosphatidylcholine(PPC). The key observation was liver function (ALT, AST, TBIL) and cytokine levels (IFN-γ, IL-10, TNF-α).Results The total effective rates were significantly higher in observation group than in control group (100% vs 76.0%, P<0.01). Compared with before treatment, IFN-γ, IL-10, and TNF-α in both groups were lower after treatment (all P<0.05), and the indexes were significantly decreased in observation group (all P<0.05). Pearson correlation analysis showed the cytokine levels were positively correlated with ALT in both groups at different time points.Conclusion MgIG can quickly improve liver function in mild AT-DILI, which may relate to the reduction of inflammatory cytokines.

Key words: chemical and drug induced liver injury, antituberculosis drugs, magnesium isoglycyrrhizinate, polyene phosphatidylcholine, cytokines

中图分类号:

R575.1

杨智彬, 邵艳芳, 潘丽, 杨艳霞, 杨宇溪, 赵丽惠, 曾荣昆, 李阳, 王巧凤, 王聪, 马世武. 异甘草酸镁治疗抗结核药物性肝损伤疗效[J]. 临床荟萃, 2021, 36(11): 972-975.

Yang Zhibin, Shao Yanfang, Pan Li, Yang Yanxia, Yang Yuxi, Zhao Lihui, Zeng Rongkun, Li Yang, Wang Qiaofeng, Wang Cong, Ma Shiwu. Efficacy of magnesium isoglycyrrhizinate in anti-tuberculosis drug-induced liver injury[J]. Clinical Focus, 2021, 36(11): 972-975.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.11.002

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I11/972

图/表 4

参考文献 28

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组别	例数	ALT(U/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	162.48±26.29	99.48±14.52^*	65.96±13.08^*	36.76±7.29^*
对照组	25	159.76±25.49	131.01±24.78^*	90.32±11.61^*	63.56±12.86^*
组间		F=5.341 P=0.030
时点间		F=47.418 P=0.000
组间·时点间		F=8.586 P=0.001
组别	例数	AST(U/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	124.80±21.62	68.96±12.16^*	55.60±10.11^*	33.80±6.11^*
对照组	25	111.40±22.10	96.83±18.73^*	75.00±14.79^*	67.68±12.14^*
组间		F=50.391 P=0.000
时点间		F=14.705 P=0.000
组间·时点间		F=3.408 P=0.035
组别	例数	TBIL(μmol/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	14.12±2.71	9.04±1.86^*	8.27±1.62^*	8.01±1.60^*
对照组	25	12.58±2.41	9.70±1.66^*	8.72±1.82^*	8.74±1.68^*
组间		F=0.012 P=0.914
时点间		F=7.953 P=0.001
组间·时点间		F=0.564 P=0.645

组别	例数	ALT(U/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	162.48±26.29	99.48±14.52^*	65.96±13.08^*	36.76±7.29^*
对照组	25	159.76±25.49	131.01±24.78^*	90.32±11.61^*	63.56±12.86^*
组间		F=5.341 P=0.030
时点间		F=47.418 P=0.000
组间·时点间		F=8.586 P=0.001
组别	例数	AST(U/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	124.80±21.62	68.96±12.16^*	55.60±10.11^*	33.80±6.11^*
对照组	25	111.40±22.10	96.83±18.73^*	75.00±14.79^*	67.68±12.14^*
组间		F=50.391 P=0.000
时点间		F=14.705 P=0.000
组间·时点间		F=3.408 P=0.035
组别	例数	TBIL(μmol/L)
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	14.12±2.71	9.04±1.86^*	8.27±1.62^*	8.01±1.60^*
对照组	25	12.58±2.41	9.70±1.66^*	8.72±1.82^*	8.74±1.68^*
组间		F=0.012 P=0.914
时点间		F=7.953 P=0.001
组间·时点间		F=0.564 P=0.645

组别	例数	INF-γ
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	136.57±28.08	68.28±14.82^*	31.70±6.31^*	10.97±1.53^*
对照组	25	137.01±27.21	108.96±20.86^*	62.57±11.40^*	41.79±6.92^*
组间		F=4.632 P=0.042
时点间		F=33.258 P=0.000
组间·时点间		F=8.791 P=0.001
组别	例数	IL-10
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	6.84±1.04	3.42±0.33^*	1.59±0.38^*	1.28±0.21^*
对照组	25	6.68±1.02	4.60±0.83^*	3.53±0.65^*	3.24±0.21^*
组间		F=24.265 P=0.000
时点间		F=128.602 P=0.000
组间·时点间		F=17.295 P=0.000
组别	例数	TNF-α
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	15.04±2.64	7.34±1.53^*	3.22±0.61^*	1.24±0.23^*
对照组	25	11.86±2.40	10.35±2.19^*	9.10±1.44^*	6.27±1.16^*
组间		F=29.298 P=0.000
时点间		F=35.070 P=0.000
组间·时点间		F=13.425 P=0.000

组别	例数	INF-γ
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	136.57±28.08	68.28±14.82^*	31.70±6.31^*	10.97±1.53^*
对照组	25	137.01±27.21	108.96±20.86^*	62.57±11.40^*	41.79±6.92^*
组间		F=4.632 P=0.042
时点间		F=33.258 P=0.000
组间·时点间		F=8.791 P=0.001
组别	例数	IL-10
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	6.84±1.04	3.42±0.33^*	1.59±0.38^*	1.28±0.21^*
对照组	25	6.68±1.02	4.60±0.83^*	3.53±0.65^*	3.24±0.21^*
组间		F=24.265 P=0.000
时点间		F=128.602 P=0.000
组间·时点间		F=17.295 P=0.000
组别	例数	TNF-α
组别	例数	治疗前	治疗1周	治疗2周	治疗3周
观察组	25	15.04±2.64	7.34±1.53^*	3.22±0.61^*	1.24±0.23^*
对照组	25	11.86±2.40	10.35±2.19^*	9.10±1.44^*	6.27±1.16^*
组间		F=29.298 P=0.000
时点间		F=35.070 P=0.000
组间·时点间		F=13.425 P=0.000

组别	例数	显效	有效	无效	总有效
观察组	25	22(88.0)	3(12.0)	0(0.0)	25(100.0)
对照组	25	14(56.0)	5(20.0)	6(24.0)	19(76.0)