甘草酸二铵联合多烯磷脂酰胆碱治疗抗结核药物所致肝损伤的疗效观察

摘要/Abstract

摘要： 目的比较多烯磷脂酰胆碱联合甘草酸二铵与单用甘草酸二铵治疗抗结核药物所致肝损伤的临床疗效及安全性。方法纳入2022年1月至2025年6月东部战区总医院住院接受抗结核治疗期间发生药物性肝损伤(DILI)的患者86例,其中采用多烯磷脂酰胆碱+甘草酸二铵治疗42例,仅采用甘草酸二铵治疗44例。比较两组临床疗效、安全性及对氧化应激相关生化指标。结果治疗4周后,联合治疗组ALT、AST、TBil水平均显著下降,分别为38(28,50)U/L、34(27,44)U/L和(18.9±7.6)μmol/L,单一治疗组分别为51(33,70)U/L、52(40,67)U/L和(25.1±8.4)μmol/L(均P<0.05)。联合治疗组ALT恢复至正常的时间为(12.3±4.1)d,显著短于单一治疗组的(18.7±5.6)d(P<0.05)。两组治疗期间总体不良事件发生率分别为16.7%(7/42)与29.5%(13/44),差异无统计学意义(P>0.05)。联合治疗组进展为重度DILI的比例为2.4%,显著低于单一治疗组的13.6%(P<0.05),住院中位时间更短,为7(5,9)d比 10(8,13)d(P<0.05)。治疗后,联合治疗组血清MDA下降幅度为(-1.8±0.6)μmol/L,明显大于单一治疗组的(-0.9±0.4)μmol/L(P<0.05);SOD提升幅度为(12.5±4.2) μmol/L 比(6.1±2.8)μmol/L(P<0.05),联合治疗组更显著。两组3个月复发率分别为4.8%(2/42)和15.9%(7/44),差异无统计学意义(P>0.05)。结论多烯磷脂酰胆碱联合甘草酸二铵治疗抗结核药物所致肝损伤可显著改善患者肝功能指标,加速肝酶恢复,减少重度肝损伤发生,且安全性良好。

关键词: 药物性肝损伤, 抗结核药, 多烯磷脂酰胆碱, 甘草酸二铵

Abstract: Objective To evaluate the clinical efficacy, safety, and effects on oxidative stress-related biochemical indicators of polyene phosphatidylcholine combined with diammonium glycyrrhizinate in patients with anti-tuberculosis drug-induced liver injury (DILI). Methods A total of 86 patients who diagnosed with DILI during anti-tuberculosis therapy and were hospitalized in our institution between January 2022 and June 2025 were enrolled. According to the hepatoprotective regimen, patients were divided into an observation group (polyene phosphatidylcholine injection + diammonium glycyrrhizinate injection, n=42) and a control group (diammonium glycyrrhizinate injection alone, n=44). The clinical efficacy, safety, and changes in oxidative stress-related biochemical markers were compared between the two groups. Results After 4 weeks of treatment, the levels of ALT, AST, and TBil in the observation group significantly decreased to 38 (28, 50) U/L, 34 (27, 44) U/L, and (18.9±7.6) μmol/L, respectively. The reductions in the observation group were significantly greater than those in the control group [51 (33, 70) U/L, 52 (40, 67) U/L, and (25.1±8.4) μmol/L, all P<0.05]. The average time for ALT to return to normal in the observation group was (12.3±4.1) days, significantly shorter than that in the control group [(18.7±5.6) days, P<0.05]. The overall incidence of adverse events during treatment was 16.7% (7/42) in the observation group and 29.5% (13/44) in the control group, with no statistically significant difference (P>0.05). The proportion of patients progressing to severe DILI in the observation group (2.4%) was significantly lower than that in the control group (13.6%, P<0.05), and the median hospital stay was shorter [7 (5, 9) days vs. 10 (8, 13) days, P<0.05]. After treatment, the reduction in serum MDA in the observation group [(-1.8±0.6) μmol/L] was significantly greater than that in the control group [(-0.9±0.4) μmol/L, P<0.05], and the increase in SOD [(12.5±4.2) μmol/L vs. (6.1±2.8) μmol/L, P<0.05] was also more significant. The 3-month recurrence rates were 4.8% (2/42) in the observation group and 15.9% (7/44) in the control group, with no statistically significant difference (P>0.05). Conclusion Polyene phosphatidylcholine combined with diammonium glycyrrhizinate significantly improves liver function, accelerates liver enzyme recovery, and reduces the incidence of severe liver injury in patients with anti-tuberculosis DILI, with good safety and tolerability.

Key words: Drug-induced liver injury, Anti-tuberculosis drugs, Polyene phosphatidylcholine, Diammonium glycyrrhizinate

杜德慧, 吴安妮, 邢婧, 王玥坤, 刘畅. 甘草酸二铵联合多烯磷脂酰胆碱治疗抗结核药物所致肝损伤的疗效观察[J]. 肝脏, 2026, 31(4): 549-552.

DU De-hui, WU An-ni, XING Jing, WANG Yue-kun, LIU Chang. Efficacy of polyene phosphatidylcholine combined with diammonium glycyrrhizinate in the treatment of anti-tuberculosis drug-induced liver injury[J]. Chinese Hepatolgy, 2026, 31(4): 549-552.

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