2019 年第 3 期 第 14 卷

不同保肝药物治疗抗类风湿药物所致药物性肝损伤的效果及药物成本比较

Effect and economic comparison among different liver protective drugs in treatment of anti-rheumatoid drug-induced liver injury

作者：李荣霞刘洁赵玲琳刘翔杨成双

英文作者：

单位：810007西宁，青海省人民医院急诊科

英文单位：

关键词：药物性肝损伤；异甘草酸镁；还原型谷胱甘肽；促肝细胞生长素；抗类风湿药物

英文关键词：

• 摘要：

• 【摘要】目的    比较还原型谷胱甘肽、异甘草酸镁和促肝细胞生长素3种药物治疗抗类风湿药物所致药物性肝损伤的效果及药物成本。方法    选取青海省人民医院2015年10月至2017年10月收治的抗类风湿药物所致药物性肝损伤患者159例，应用随机数字表法将其分为A组、B组及C组，各53例。A组患者给予还原型谷胱甘肽注射液治疗，B组患者给予异甘草酸镁注射液治疗，C组患者给予促肝细胞生长素注射液治疗，治疗时间均为2周，比较3组患者临床疗效、治疗前后肝功能指标［丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素及谷氨酰转肽酶(GGT)］水平、不良反应发生率和药物成本。结果    A组、B组及C组患者的治疗总有效率比较差异无统计学意义(P>0.05)。治疗前，3组患者血清肝功能指标水平比较差异均无统计学意义(均P>0.05)。治疗后，3组患者血清ALT、AST、总胆红素及GGT水平均低于治疗前，且B组均低于A组和C组［(42±5)U/L比（66±6）、（64±7）U/L，(56±7)U/L比（79±8）、（81±8）U/L，(16.1±2.0)μmol/L比（20.4±2.4）、（19.8±2.5）μmol/L，(141±8)U/L比（188±10）、（190±12）U/L］(均P<0.05)，但A组与C组比较差异均无统计学意义(均P>0.05)。A组、B组及C组不良反应发生率比较差异无统计学意义(P>0.05)。B组药物成本低于A组及C组［(974±122)元比（1 482±250）、（1 305±146）元］，且C组低于A组，差异均有统计学意义（均P<0.05）。结论    异甘草酸镁较还原型谷胱甘肽、促肝细胞生长素对抗类风湿药物所致药物性肝损伤患者的肝功能改善作用更好、药物成本更低，且不明显增加不良反应。

• 【Abstract】Objective    To analyze the efficacy and cost of different hepatoprotective drugs in treatment of anti-rheumatoid drug-induced liver injury. Methods    A total of 159 patients with liver injury caused by anti-rheumatoid drugs admitted to Qinghai Provincial People′s Hospital from October 2015 to October 2017 were randomly divided into group A, group B and group C, with 53 patients in each group. Group A was treated with reduced glutathione; group B was treated with magnesium isoglycyrrhizinate; group C was treated with hepatocyte growth-promoting factor. After 2 weeks of treatment, clinical efficacy, liver function［alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin（TBIL） and glutamyltranspetidase(GGT)］, adverse reactions and drug cost were analyzed. Results    Total effective rate showed no significant difference among the three groups(P>0.05). Before treatment, there was no significant difference of serum liver function indexes among groups(P>0.05). After treatment, levels of serum ALT, AST, TBIL and GGT significantly decreased and the levels in group B were significantly lower than those in group A and group C［(42±5)U/L vs （66±6）,（64±7）U/L; (56±7)U/L vs （79±8）,（81±8）U/L; (16.1±2.0)μmol/L vs （20.4±2.4）,（19.8±2.5）μmol/L; (141±8)U/L vs （188±10）,（190±12）U/L］(all P<0.05); there was no significant difference between group A and group C(all P＞0.05). There was no significant difference of the incidence of adverse reactions among groups(P>0.05). Cost of drugs in group B was significantly lower than that in group A and group C［(974±122)yuan vs （1 482±250）,（1 305±146）yuan］; the cost in group C was significantly lower than that in group A（all P<0.05）. Conclusion    Magnesium isoglycyrrhizinate shows better effect on liver function recovery and lower medical cost than reducedglutathione and hepatocyte growth-promoting factor in treatment of anti-rheumatoid drug-induced liver injury and does not increase adverse reactions.