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目的 研究复方甘草酸苷(SNMC)联合还原型谷胱甘肽(GSH)在缓解抗结核治疗患者肝损伤中的应用效果。方法 江山市人民医院2020年1月至2024年8月收治的98例抗结核治疗相关肝损伤患者，分为采用常规治疗及水飞蓟宾治疗的水飞蓟宾组和在水飞蓟宾组基础上加用SNMC、GSH治疗的联合组，分组方法为随机数字表法，两组均连续治疗2周。比较两组临床疗效、血清氧化应激指标、炎症因子、肝功能指标水平及安全性。结果 治疗后，联合组总有效率为91.84%(45/49)，高于水飞蓟宾组的75.51%(37/49)(χ2=4.780,P<0.05)。治疗后，联合组和水飞蓟宾组血清超氧化物歧化酶、谷胱甘肽过氧化物酶水平[分别是(589.52±71.37)U·L-1、(73.41±8.40)U·L-1和(519.82±62.74)U·L-1、(66.29±7.17)U·L-1]，高于治疗前[分别是(324.06±44.17)U·L-1、(52.78±7.29)U·L-1和(321.73±39.82)U·L-1、(53.92±6.72)U·L-1]，且联合组高于水飞蓟宾组(t=5.134、4.513,P<0.05)；血清丙二醛水平[(3.89±1.14)nmol·L-1和(6.17±1.95)nmol·L-1]低于治疗前[(8.69±2.77)nmol·L-1和(8.35±2.51)nmol·L-1]，且联合组低于水飞蓟宾组(t=7.066,P<0.05)。治疗后联合组和水飞蓟宾组血清白细胞介素6、白细胞介素1β、C反应蛋白[分别是(3.88±1.27)ng·L-1、(10.69±2.50)μg·L-1、(8.59±2.05)mg·L-1和(8.44±2.39)ng·L-1、(22.48±4.03)μg·L-1、(16.27±4.52)mg·L-1]低于治疗前[分别是(19.33±4.52)ng·L-1、(58.11±8.51)μg·L-1、(23.10±6.83)mg·L-1和(18.53±3.28)ng·L-1、(57.29±7.34)μg·L-1、(22.47±6.02)mg·L-1]，且联合组低于水飞蓟宾组(t=11.794、17.402、10.832,P<0.05)。治疗后联合组和水飞蓟宾组血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰基转移酶水平[分别是(34.19±5.27)U·L-1、(40.95±4.72)U·L-1、(35.61±5.22)U·L-1和(51.38±7.32)U·L-1、(57.41±7.83)U·L-1、(57.07±8.49)U·L-1]低于治疗前[分别是(150.31±25.48)U·L-1、(134.41±36.70)U·L-1、(92.41±9.40)U·L-1和(149.78±23.69)U·L-1、(133.52±31.58)U·L-1、(91.78±8.48)U·L-1]，且联合组低于水飞蓟宾组(t=13.341、12.603、15.073,P<0.05)。水飞蓟宾组不良反应总发生率为10.20%(5/49)，联合组为14.29%(7/49)，两组比较差异无统计学意义(χ2=0.380,P=0.538)。结论 SNMC联合GSH治疗抗结核治疗相关肝损伤患者，可有效缓解患者机体氧化应激反应，降低其炎症反应，改善患者肝功能，安全性良好。
Abstract：Objective To observe the effect of stronger neo-minophagen C (SNMC) combined with reduced glutathione (GSH)on relieving the antituberculosis therapy-related liver injury.Methods A total of 98 patients with antituberculosis therapy-related liver injury who were admitted to the Jiangshan People’s Hospital from January 2020 to August 2024 were divided into the silybin group treated with conventional treatment and silybin,and the combination group treated with SNMC and GSH on the basis of the silybin group.The enrolled patients were randomly grouped,and both groups were treated continuously for 2 weeks.The clinical efficacy,serum oxidative stress indexes,inflammatory factors,liver function indexes and safety were compared between the two groups.Results The total effective rate of the combination group was 91.84%(45/49) after the treatment,higher than 75.51%(37/49) of the silybin group (χ2=4.780,P<0.05).The levels of serum superoxide dismutase and glutathione peroxidase of the combination group and the silybin group were respectively (589.52±71.37) U·L-1,(73.41±8.40) U·L-1 and (519.82±62.74) U·L-1 and (66.29±7.17) U·L-1after the treatment,higher than (324.06±44.17) U·L-1,(52.78±7.29) U·L-1 and (321.73±39.82) U·L-1,(53.92±6.72) U·L-1 before the treatment.The levels of the above indexes of the combination group were higher than those of the silybin group (t=5.134,4.513,P<0.05).The levels of serum malondialdehyde were respectively (3.89±1.14) nmol·L-1 and (6.17±1.95) nmol·L-1 after the treatment,lower than (8.69±2.77) nmol·L-1 and (8.35±2.51) nmol·L-1 before the treatment.The levels of the above indexes of the combination group were lower than those of the silybin group (t=7.066,P<0.05).The levels of serum interleukin-6,interleukin-1β and tumor C-reactive protein of the combination group and the silybin group were respectively (3.88±1.27) ng·L-1,(10.69±2.50)μg·L-1,(8.59±2.05) mg·L-1 and (8.44±2.39) ng·L-1,(22.48±4.03)μg·L-1 and (16.27±4.52) mg·L-1 after the treatment,lower than[(19.33±4.52) ng·L-1,(58.11±8.51)μg·L-1,(23.10±6.83) mg·L-1 and (18.53±3.28) ng·L-1,(57.29±7.34)μg·L-1 and (22.47±6.02) mg·L-1 before the treatment.The levels of the above indexes of the combination group were lower than those of the silybin group (t=11.794,17.402,10.832,P<0.05).The levels of serum alanine aminotransferase,aspartate aminotransferase and γ-glutamyl transferase of the combination group and the silybin group were respectively (34.19±5.27) U·L-1,(40.95±4.72) U·L-1,(35.61±5.22) U·L-1 and (51.38±7.32) U·L-1,(57.41±7.83) U·L-1 and (57.07±8.49) U·L-1 after the treatment,lower than (150.31±25.48) U·L-1,(134.41±36.70) U·L-1,(92.41±9.40) U·L-1 and (149.78±23.69) U·L-1,(133.52±31.58) U·L-1 and (91.78±8.48) U·L-1 before the treatment.The levels of the above indexes of the combination group were lower than those of the silybin group (t=13.341,12.603,15.073,P<0.05).The total incidence of adverse reactions was 10.20%(5/49) in the silybin group,14.29%(7/49) in the combination group and there was no significant difference between the two groups (χ2=0.380,P=0.538).Conclusion SNMC combined with GSH in the treatment of patients with antituberculosis therapy-related liver injury can effectively alleviate the oxidative stress response of patients,reduce their inflammatory response,improve their liver function,and have good safety.
[1] Lewis JH, Korkmaz SY, Rizk CA, et al. Diagnosis, prevention and risk-management of drug-induced liver injury due to medications used to treat mycobacterium tuberculosis[J]. Expert Opin Drug Saf, 2024, 23(9):1093-1107.
[2] Meitei HN, Pandey A, Haobam R. Polymorphisms in drug metabolism genes as a risk factor for first-line anti-tuberculosis drug-induced liver injury[J]. Mol Biol Rep, 2023, 50(3):2893-2900.
[3]莫俊俏，林景，羊莉.水飞蓟宾胶囊联合多烯磷脂酰胆碱治疗抗结核药物所致药物性肝损伤患者疗效研究[J].实用肝脏病杂志，2023,26(5):666-669.
[4]钱婷婷，朱旭婷，卢吟秋，等.肝损伤代谢组学模型的构建及其中药提取物水飞蓟宾治疗的评价[J].分析科学学报，2021,37(5):581-586.
[5]鞠爱霞，胡勇，单万亭，等.基于转运体MRP2和P-gp研究甘草酸对雷公藤多苷所致肝损伤的保护作用及机制[J].中南药学，2021,19(12):2496-2501.
[6]王俊红，戴玲，陈国斌，等. GSH、甘草酸二铵和SNMC治疗抗结核药物所致药物性肝损伤患者成本-效益分析[J].实用肝脏病杂志，2023,26(3):380-383.
[7]于乐成，茅益民，陈成伟.药物性肝损伤诊治指南[J].实用肝脏病杂志，2017,20(2):257-274.
[8]中华医学会结核病学分会，结核病病理学诊断专家共识编写组.中国结核病病理学诊断专家共识[J].中华结核和呼吸杂志，2017,40(6):419-425.
[9] Wang M, Zhang L, Yue H, et al. Peptides from antarctic krill(Euphausia superba)ameliorate acute liver injury in mice induced by carbon tetrachloride via activating the Nrf2/HO-1 pathway[J].Food Funct, 2023, 14(8):3526-3537.
[10] Pan Y, Tang P, Cao J, et al. Lipid peroxidation aggravates anti-tuberculosis drug-induced liver injury:evidence of ferroptosis induction[J]. Biochem Biophys Res Commun, 2020, 533(4):1512-1518.
[11] Zhang B, Jiang G, Wang L, et al. An analysis of silybin meglumine tablets in the treatment of drug-induced liver injury as assessed for causality with the updated roussel uclaf causality assessment method using a nationwide database[J]. Br J Clin Pharmacol, 2023, 89(4):1329-1337.
[12] Cai L, Ming D, Chen W, et al. Silybin alleviated hepatic injury by regulating redox balance, inflammatory response, and mitochondrial function in weaned piglets under paraquat-induced oxidative stress[J]. Antioxidants(Basel), 2024, 13(3):324-324.
[13] Medina-Caliz I, Sanabria-Cabrera J, Villanueva-Paz M, et al.Characterization of drug-induced liver injury associated with drug reaction with eosinophilia and systemic symptoms in two prospective DILI registries[J]. Arch Toxicol, 2024, 98(1):303-325.
[14] Wang D, Cai XL, Lin X, et al. Hepatoprotective drugs for prevention of liver injury resulting from anti-tuberculosis treatment:a meta-analysis of cohort studies[J]. Infect Med(Beijing), 2022, 1(3):154-162.
[15] Ezhilarasan D. Antitubercular drugs induced liver injury:an updated insight into molecular mechanisms[J]. Drug Metab Rev,2023, 55(3):239-253.
[16] Huang CK, Huang JY, Chang CH, et al. The effect of statins on the risk of anti-tuberculosis drug-induced liver injury among patients with active tuberculosis:a cohort study[J]. J Microbiol Immunol Infect, 2024, 57(3):498-508.
[17]卫栋萍，韩黎黎，凌佳慧，等.甘草酸二胺与SNMC治疗环磷酰胺所致的药物性肝损伤患者疗效研究[J].实用肝脏病杂志，2023,26(3):388-391.
[18]李梅，王丽，夏亚飞，等.基于PI3K/Akt/NF-κB通路探讨SNMC对病毒性肺炎小鼠肺损伤的保护作用[J].中成药，2023,45(11):3775-3779.
[19] Zhang H, Jin B, Liu L, et al. Glutathione might attenuate arsenic-induced liver injury by modulating the Foxa2-XIAP axis to reduce oxidative stress and mitochondrial apoptosis[J]. Biol Trace Elem Res, 2023, 201(11):5201-5212.
[20] Oda S, Miyazaki N, Tsuneyama K, et al. Exacerbation of gefitinib-induced liver injury by glutathione reduction in mice[J]. J Toxicol Sci, 2020, 45(8):493-502.
[21] Moosa MS, Maartens G, Gunter H, et al. A randomized controlled trial of intravenous n-acetylcysteine in the management of anti-tuberculosis drug-induced liver injury[J]. Clin Infect Dis, 2021, 73(9):3377-3383.
[22] Huang D, Peng J, Lei L, et al. Time of liver function abnormal identification on prediction of the risk of anti-tuberculosis-induced liver injury[J]. J Clin Transl Hepatol, 2023, 11(2):425-432.
[23]付小桐,刘婷,曹春雨,等.基于P450酶的雷公藤多苷致大鼠肝损伤及其与SNMC配伍减毒研究[J].中国药物警戒, 2023,20(1):85-91.
[24]袁媛,陈洁,邓兰,等. SNMC对慢性乙型肝炎患者IL-17、IL-6、TGF-β、MMP-2表达的影响[J].检验医学与临床, 2020,17(6):751-754.
[25] Zhang W, Wang X, Li P, et al. Evaluating hyperthyroidism-induced liver injury based on in situ fluorescence imaging of glutathione and phosphate via Nano-MOFs sensor[J]. Anal Chem, 2020, 92(13):8952-8958.
[26] Li Y, Liang K, Yuan L, et al. The role of thioredoxin and glutathione systems in arsenic-induced liver injury in rats under glutathione depletion[J]. Int J Environ Health Res, 2024, 34(1):547-563.
基本信息:
DOI：
中图分类号:R521;R575
引用信息:
[1]夏明,王菲,陈和敏.复方甘草酸苷联合还原型谷胱甘肽缓解抗结核治疗相关肝损伤的临床研究[J].中国药物应用与监测,2025,22(03):438-442.
基金信息: