异甘草酸镁治疗HIV/MTB双重感染合并ATB-DILI患者的临床研究

Clinical study of magnesium isoglycyrrhizinate in the treatment of HIV/MTB co-infection patients with anti-tuberculosis drug-induced liver injury

目的:探讨异甘草酸镁治疗艾滋病病毒/结核分枝杆菌(HIV/MTB)双重感染合并抗结核药物性肝损伤(ATB-DILI)患者的临床疗效和安全性。方法:选取2019年9月至2020年12月凉山州布拖县人民医院诊治的200例HIV/MTB双重感染合并ATB-DILI患者,随机分为观察组101例和对照组99例。观察组给予异甘草酸镁注射液100 mg,每日1次,对照组则给予还原型谷胱甘肽注射液1.2 g,每日1次,疗程均为2周。比较2组治疗后肝功能生化指标、症状和体征、临床总有效率、CD4^(+)T淋巴细胞数、血清炎性指标及不良反应发生情况。结果:2组血清ALT、AST、TBIL、ALP和γ-GT水平均较治疗前有明显降低,且观察组显著低于对照组(P<0.05)。2组临床症状和体征均较治疗前有明显改善,且观察组显著优于对照组(P<0.05)。观察组临床总有效率显著高于对照组(P<0.05)。2组血清CD4^(+)T淋巴细胞数水平均较治疗前有明显增加,且治疗2周后观察组显著高于对照组(P<0.05)。2组患者WBC、PCT、Hs-CRP和ESR均较治疗前有明显降低,组间比较差异无统计学意义(P>0.05)。2组患者药物不良反应发生率相仿,组间比较差异无统计学意义(P>0.05)。结论:异甘草酸镁治疗HIV/MTB双重感染合并ATB-DILI患者的临床疗效显著,不仅能明显改善临床症状和体征,还可以促进肝功能恢复,并对机体免疫重建有一定作用,且未增加不良反应发生风险。

OBJECTIVE To explore the clinical efficacy and safety of magnesium isoglycyrrhizinate in the treatment of human immunodeficiency virus and mycobacterium tuberculosis(HIV/MTB) co-infected patients with anti-tuberculosis drug-induced liver injury(ATB-DILI).METHODS From September 2019 to December 2020, a total of 200 HIV/MTB co-infected ATB-DILI patients were diagnosed and treated. They were divided randomly into two groups of observation(n=101) and control(n=99). The observation group received an injection of 100 mg magnesium isoglycyrrhizinate once daily while the control group an injection of 1.2 g reduced glutathione once daily for 2 weeks. Biochemical parameters of liver function, symptoms & signs, clinical overall effective rate, CD4^(+)T lymphocyte count, serum inflammatory parameters and the incidence of adverse reactions were compared between two groups post-treatment.RESULTS Serum levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), alkaline phosphatase(ALP) and glutamyl transpeptidase(γ-GT) declined markedly after treatment in two groups and the parameters of observation group were lower than those of control group(P<0.05). Clinical symptoms and signs obviously improved in both groups and the extent of observation group was better than that of control group(P<0.05). The clinical overall effective rate after treatment was higher in observation group than that in control group(P<0.05). Serum count of CD4^(+)T lymphocyte spiked greatly after treatment and the efficacy was superior in observation group to that in control group after 2 weeks(P<0.05). White blood cell(WBC), procalcitonin(PCT), hypersensitive C-reactive protein(Hs-CRP) and erythrocyte sedimentation rate(ESR) after treatment decreased obviously in both groups. However, there were no inter-group statistical differences(P>0.05). The incidence of adverse reactions in 2 groups was comparable without statistical differences(P>0.05).CONCLUSION Using magnesium isoglycyrrhizinate in the treatment of HIV/MTB co-infected ATB-DILI patients demonstrates remarkable clinical efficacies. This regimen can not only significantly improve the clinical symptoms and signs, but also promote the recovery of liver function. It plays a certain role in body immunity reconstruction without an elevated risk of adverse reactions.