接受雷公藤制剂治疗的类风湿性关节炎并发药物性肝损害患者临床特征及预后分析

Clinical feature of rheumatoid arthritis patients with drug-induced liver injury after tripterygium wilfordii preparation treatment

目的分析总结接受雷公藤制剂治疗的类风湿性关节炎(RA)并发药物性肝损害(DILI)患者临床特征及预后情况。方法2019年1月~2023年10月我院收治的60例RA并发DILI患者,均有应用雷公藤制剂治疗,经RUCAM量表评分诊断。结果在60例患者中,年龄大于46岁者占75.0%,应用雷公藤制剂超过4个月者占比为40.0%;RUCAM量表评分大于5分者占比为88.3%,肝细胞损伤型占比为66.7%,肝损伤1/2级占比为50.0%;治疗RA用药为雷公藤制剂(A组)、雷公藤制剂联合糖皮质激素(B组)、雷公藤制剂联合非甾体类抗炎药(C组)和雷公藤制剂联合糖皮质激素和非甾体类抗炎药(D组)分别为10例、12例、30例和8例,D组血生化指标相对高于其他各组(P<0.05);经临床护肝治疗7~75d,平均(23.4±7.0)d,治愈率为43.3%,临床好转率为50.0%,肝功能指标未恢复率为6.7%。结论RA患者应用含雷公藤制剂方案治疗可能容易引起肝损伤,用药越多,肝损伤可能更明显,但大多预后良好。

Objective This study was to investigate clinical features of rheumatoid arthritis(RA)patients with complicated drug-induced liver injury(DILI)after administration of herbal medicine,tripterygium wilfordii preparation trerament.Methods Sixty patients with RA and DILI were encountered in our hospital between January 2019 and October 2023,all had received treatment regimen containing tripterygium wilfordii preparation,and DILI was diagnosed by the Roussel Uclaf Causality Assessment Method(RUCAM).Results Of the 60 patients with RA and DILI,older than 46 years accounted for 75.0%,and longer than 4 months of tripterygium wilfordii preparation administration accounted for 40.0%;percentage of greater than five points of RUCAM score accounted for 88.3%,hepatocyte injury type accounted for 66.7%,and 1/2 grade of liver injuries accounted for 50.0%;the regimen for RA treatment included tripterygium wilfordii preparation(group A),tripterygium wilfordii preparation and steroids(group B),tripterygium wilfordii preparation and nonsteroidal anti-inflammatory agents(group C)and tripterygium wilfordii preparation,steroids and nonsteroidal anti-inflammatory agent combination(group D)in 10 cases,12 cases,30 cases and 8 cases,blood biochemical parameters in group D were significantly higher than those in other three groups(P<0.05);26 patients(43.3%)recovered,30 patients(50.0%)improved,and 4(6.7%)discharged without liver function test normal after(23.4±7.0)day liver-protecting treatment.Conclusion Patients with rheumatoid arthritis are susceptible to liver injury after treatment of regimens containing tripterygium wilfordii preparation,the liver injuries might be even severe when too many drug combination administered,and fortunately,the prognosis is good.