不同保肝药物对防治抗结核药所致肝损伤的疗效比较

Comparison of the efficacy of different hepatoprotective drugs on the prevention and treatment of liver injury induced by antituberculosis drugs

目的:评价不同保肝药物防治抗结核药所致肝损伤的疗效。方法:360例患者随机分为2组,对照组直接给予化疗药物,试验组化疗药、保肝药同时启用,试验者分为A组(甘草酸二铵)、B组(多烯磷脂酰胆碱)、C组(双环醇),治疗30 d后观察肝功能指标,并进行成本-效果分析。结果:对照组发生肝损害50例,占27.8%,试验组发生肝损害13例,占7.2%,2组比较P<0.01。A、B、C组发生肝损害率分别为11.7%、1.7%、8.3%,A、B组比较P<0.01,B、C组比较P>0.05,A、C组比较P>0.05。3组保肝药的疗效以B组最好,A组最低,成本及成本-效果比也以A组最低。结论:化疗药与保肝药同时应用,能显著提高肝脏拮抗结核药损害的能力,降低肝损害发生率。结合成本-效果比分析,B组方案比较合理。

OBJECTIVE To compare the efficacy of different hepatoproteetive drugs on the prevention and treatment of liver injury induced by antituberculosis drugs. METHODS Three hundred sixty cases of TB were randomly divided into the control group and the test group. The patients were given with chemotherapy in the control group, in test group the patients were given with antituberculosis drugs and liver-protective drugs in the whole course. And they were randomly divided into 3 groups：group A treated with diammonium glycyrrhizinate, group B treated with polyene phosphatidylcholine, group C treated with bicyclol. The curative effects in each group were observed and the cost-effectiveness analysis was made. RESULTS Hepatic lesion occurred 50 cases in the control group （27.8%） and 12 cases in the test group （6. 7%）. There were significant differences be tween the two groups（P〈0.01 ）. In test group A,B and C, the incidence rate of hepatic lesion was 11.7%, 1.7% and 8.3%,The hepatoprotective effect in group B was the highest, in group A was the lowest,and the cost-effectiveness ratio in group A also was the lowest. CONCLUSION Hepatoprotective drugs combined with chemotherapy drugs given in tuberculotic patients may significantly reduce the incidence of hepatic lesion. Cost effectiveness analysis indicates the option of group B is the preferable one for hepatic lesion induced by antituberculosis drugs.