目的 观察60岁以上初治结核病患者预防性保肝对降低药物性肝损伤(DILI)价值，进一步比较双环醇片与水飞蓟宾胶囊的保肝效果。方法 选取青岛市胸科医院2018年2月～2023年10月收治的186例结核病患者，均行强化治疗，对照组不给予保肝药，A组给予水飞蓟宾胶囊，B组给予双环醇片。比较3组患者治疗2、4和8周后DILI发生率。并于治疗前及治疗2、4和8周后检测3组患者超氧化物歧化酶(SOD)、血清谷胱甘肽过氧化物酶(GSH-Px)水平变化。比较3组患者不良反应发生率。结果 治疗第2和4周时，DILI发生率A组为6。34％、11。11％，B组为1。58％、9。52％，均低于对照组的11。11％、23。8％，其中B组与对照组比较差异有统计学意义(x2=4。805、4。628，P＜0。05)。治疗第8周时，A组、B组DILI发生率12。69％、14。28％，均低于对照组的28。57％，差异有统计学意义(x2=4。846、3。818，P＜0。05)。治疗2、4和8周3个时点B组SOD 水平(338。59±36。25)U/L、(342。68±25。62)U/L、(345。28±37。36)U/L 高于 A 组(228。06±23。83)U/L、(239。98±19。58)U/L、(246。25±28。73)U/L 和对照组(217。69±15。66)U/L、(205。92±29。64)U/L、(226。34±28。51)U/L，且 A 组高于对照组，差异有统计学意义(F=2。187、2。664、2。823，P＜0。05)。治疗 2 和 4 周时 B 组的 GSH-Px 水平(88。78±9。47)U/ml、(94。56±10。09)U/ml，较 A 组(80。66±6。26)U/ml、(88。89±9。35)U/ml 和对照组(82。23±8。44)U/ml、(86。65±7。39)U/ml 高，差异有统计学意义(t=5。677、3。271、4。098、5。019，P＜0。05)。除DILI外，3组不良反应发生率分别为9。52％、12。69％、11。11％，差异无统计学意义(P＞0。05)。结论 对于60岁以上初治结核患者，可考虑给予预防性保肝治疗。水飞蓟宾胶囊与双环醇片均可降低DILI发生率，相较而言双环醇片起效更快。
The preventive effect of Silibinin capsules and bicyclol tablets on drug-induced liver injury in anti-tuberculosis patients over 60 years old
Objective To observe the value of preventive hepatoprotection in reducing drug-induced liver injury(DILI)in patients over 60 years old with newly treated tuberculosis,and to further compare the hepatoprotective effect of bicyclol tablets and silibinin capsules.Methods 186 tuberculosis patients admitted from February 2018 to October 23 were selected,and all received intensive treatment.The control group was not given hepatoprotective drugs,group A was given silybin capsules,and group B was given bicyclol tablets.Compare the incidence of DILI in three groups of 2 weeks,4 weeks,and 8 weeks of treatment.Serum glutathione peroxidase(GSH Px)and superoxide dismutase(SOD)were detected,and the level changes in the three groups before treatment,2 weeks,4 weeks,and 8 weeks of treatment were compared.Compare the incidence of adverse reactions among the 3 groups.Results In the second and fourth weeks of treatment,the incidence rates of DILI in Group A were 6.34％and 11.11％and in Group B were 1.58％and 9.52％,both of which were lower than those in the control group(11.11％and 23.8％).The difference between Group B and the control group was statistically significant(x2=4.805,4.628,P＜0.05).At the 8th week of treatment,the DILI incidence rate in Group A and Group B were 12.69％and 14.28％,both lower than the control group's 28.57％(x2=4.846,3.818,P＜0.05).In weeks 2,4,and 8,the SOD levels of Group B were(338.59±36.25)U/L,(342.68±25.62)U/L,and(345.28±37.36)U/L,which were higher than those of Group A,which were(228.06±23.83)U/L,(239.98±19.58)U/L,and(246.25±28.73)U/L and the control group at(217.69±15.66)U/L,(205.92±29.64)U/L,(226.34±28.51)U/L(F=2.187、2.664、2.823,P＜0.05).The GSH Px levels of Group B at weeks 2 and weeks 4 were(88.78±9.47)U/ml,(94.56±10.09)U/ml,which were higher than those in Group A at(80.66±6.26)U/ml,(88.89±9.35)U/ml,and the control group at(82.23±8.44)U/ml,(86.65±7.39)U/ml(t=5.677,3.271,4.098,5.019,P＜0.05).Except for DILI,the incidence rates of adverse reactions in the three groups were 9.52％,12.69％,and 11.11％respectively.The differences were not statistically significant difference(P＞0.05).Conclusion For patients over 60 years old who are newly treated for tuberculosis,preventive hepatoprotective treatment can be considered.Both silybin capsules and bicyclol tablets can reduce the incidence of DILI,with bicyclic alcohol tablets having a faster onset of effect.
万方数据
维普
