Lang Susanne M, Ortmann Johannes, Rostig Sven, Schiffl Helmut
Department of Internal Medicine II, II Medizinische Klinik, SRH Wald-Klinikum Gera, Gera, Germany.
Outpatient Department, SRH Policlinic, Gera, Germany.
Int J Mycobacteriol. 2019 Jan-Mar;8(1):89-92. doi: 10.4103/ijmy.ijmy_159_18.
Tuberculosis (TB) remains a global health problem. The application of rifampicin-based regimens for antimycobacterial therapy is hampered by its marked hepatotoxicity which results in poor adherence and may contribute to prolonged therapy or treatment failure. The purpose of this prospective investigation was to evaluate the hepatoprotective effectiveness of oral ursodeoxycholic acid (UDCA) (250-500 mg TID) administered to TB- or non-TB mycobacterial (NTM)-infected patients with drug-induced hepatotoxicity and ongoing therapy.
Study population: During 2009-2017, 27 patients (11 women, 16 men, aged 19-90 years; median age 44 years, 16 Caucasians, 10 Africans, 1 Asian) out of 285 patients with active TB (24/261) or NTM infections (3/24) treated at our TB Center developed clinically relevant hepatotoxicity. Oral UDCA was administered to treat hepatotoxicity.
Twenty-one out of 27 patients (77.8%) showed normalization of elevated enzymes (alanine transferase and aspartate aminotransferase), alkaline phosphatase, and bilirubin while continuing TB treatment and 5 patients demonstrated a significant reduction of liver enzymes (18.5%). No change was observed in 1 patient (3.7%). Drug dose was not reduced in all patients; they all showed radiological and clinical improvement. There were no significant side effects.
Oral administration of UDCA to TB patients developing anti-TB drug-induced liver injury may reverse hepatotoxicity in adults.
结核病仍然是一个全球性的健康问题。基于利福平的抗分枝杆菌治疗方案的应用受到其明显肝毒性的阻碍，这种肝毒性导致依从性差，并可能导致治疗时间延长或治疗失败。这项前瞻性研究的目的是评估口服熊去氧胆酸（UDCA）（250 - 500毫克，每日三次）对患有药物性肝毒性且正在接受治疗的结核病或非结核分枝杆菌（NTM）感染患者的肝脏保护效果。
研究人群：在2009年至2017年期间，我们结核病中心治疗的285例活动性结核病患者（24/261）或NTM感染患者（3/24）中有27例（11名女性，16名男性，年龄19 - 90岁；中位年龄44岁，16名白种人，10名非洲人，1名亚洲人）出现了临床相关的肝毒性。口服UDCA用于治疗肝毒性。
27例患者中有21例（77.8%）在继续结核病治疗的同时，谷丙转氨酶、谷草转氨酶、碱性磷酸酶和胆红素水平恢复正常，5例患者的肝酶显著降低（18.5%）。1例患者（3.7%）未见变化。所有患者均未减少药物剂量；他们在影像学和临床方面均有改善。未观察到明显副作用。
对发生抗结核药物性肝损伤的结核病患者口服UDCA可能会逆转成人的肝毒性。
