Saito Zenya, Kaneko Yugo, Kinoshita Akira, Kurita Yusuke, Odashima Kyuto, Horikiri Tsugumi, Yoshii Yutaka, Seki Aya, Seki Yoshitaka, Takeda Hiroshi, Kuwano Kazuyoshi
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae-shi, Tokyo, 201-8601, Japan.
Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
BMC Infect Dis. 2016 Nov 11;16(1):668. doi: 10.1186/s12879-016-2000-6.
The effectiveness of hepatoprotective drugs for DIH (drug induced hepatotoxicity) during tuberculosis treatment is not clear. We evaluated the effectiveness of hepatoprotective drugs by comparing the period until the normalization of hepatic enzymes between patients who were prescribed with the hepatoprotective drugs after DIH was occurred and patients who were not prescribed with the hepatoprotective drugs.
During 2006-2010, 389 patients with active tuberculosis were included in this study. DIH was defined as elevation of peak serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) of more than twice the upper limit of normal (ULN). We divided the patients into the severe (peak serum AST and/or ALT elevation of >5 times the ULN), moderate (peak serum AST and/or ALT elevation of >3 to ≤5 times the ULN), and mild DIH groups (peak serum AST and/or ALT elevation of >2 to ≤3 times the ULN). We compared the average period until the normalization of hepatic enzymes between patient subgroups with and without hepatoprotective drugs (ursodeoxycholic acid: UDCA, stronger neo-minophagen C: SNMC, and glycyrrhizin).
In the severe group, there was no significant difference in the average period until the normalization between subgroups with and without hepatoprotective drugs (21.4 ± 10.8 vs 21.5 ± 11.1 days, P = 0.97). In the mild group, the period was longer in the subgroup with hepatoprotective drugs than that without hepatoprotective drugs (15.7 ± 6.2 vs 12.4 ± 7.9 days, P = 0.046).
Regardless of the severity, hepatoprotective drugs did not shorten the period until the normalization of hepatic enzymes.
抗结核治疗期间，保肝药物对药物性肝毒性（DIH）的疗效尚不清楚。我们通过比较发生DIH后使用保肝药物的患者与未使用保肝药物的患者肝酶恢复正常所需的时间，评估了保肝药物的疗效。
2006年至2010年期间，本研究纳入了389例活动性肺结核患者。DIH定义为血清天冬氨酸氨基转移酶（AST）和/或丙氨酸氨基转移酶（ALT）峰值升高超过正常上限（ULN）的两倍。我们将患者分为重度（血清AST和/或ALT峰值升高>5倍ULN）、中度（血清AST和/或ALT峰值升高>3至≤5倍ULN）和轻度DIH组（血清AST和/或ALT峰值升高>2至≤3倍ULN）。我们比较了使用和未使用保肝药物（熊去氧胆酸：UDCA、强力新诺明C：SNMC和甘草酸）的患者亚组肝酶恢复正常的平均时间。
在重度组中，使用和未使用保肝药物的亚组之间肝酶恢复正常的平均时间没有显著差异（21.4±10.8天对21.5±11.1天，P = 0.97）。在轻度组中，使用保肝药物的亚组肝酶恢复正常的时间比未使用保肝药物的亚组更长（15.7±6.2天对12.4±7.9天，P = 0.046）。
无论严重程度如何，保肝药物均未缩短肝酶恢复正常的时间。
