还原型谷胱甘肽对抗结核治疗致ALT异常的作用及其机制探讨

目的:探讨还原型谷胱甘肽对抗结核药物致谷氨酸氨基转移酶(ALT)异常的预防作用及其机制。方法:178例结核病患者随机分为治疗组(n=93)和对照组(n=85),在抗结核治疗最初2个月,治疗组采用抗结核病方案+还原型谷胱甘肽1.2g加入0.9%氯化钠注射液250mL中,静脉滴注,qd;对照组采用抗结核方案+葡醛内酯片0.2g,口服,tid。所有病例治疗前及治疗最初2个月每2周查肝肾功能、血常规及过氧化脂质(LPO)各1次。结果:治疗组和对照组患者2个月内ALT异常发生率分别为10.8%和27.1%,2组比较有显著性差异(P<0.05)。肝损害发生后患者的LPO水平有所提高,与治疗前及无肝损害者相比,差异有统计学意义(P<0.05),对照组血清LPO水平明显高于治疗组(P<0.05)。结论:抗结核药物所致肝损害与体内的LPO过氧化有关,应用还原型谷胱甘肽能减少体内LPO产生,显著降低肝损害的发生率。

Effects of Reduced Glutathione on Abnormal ALT of Anti-tuberculosis Treatment and Its Mechanism

OBJECTIVE： To discuss the prevention function and mechanism of Reduced glutathione resisting tuberculosis medicine-induced hepatic injury. METHODS： 178 tuberculosis patients were randomly divided into treatment group （n=93） and control group （n=85）. At the first 2 months of anti-tuberculosis treatment, treatment group was given Reduced glutathione 1.2 g and 0.9% Sodium chloride injection 250 mL via i.v. gtt qd on the basis of anti-tuberculosis treatment. Control group was given oral dose of Glucurolactone tablets 0.2 g tid. Liver and kidney function, blood routine and LPO of patients were determined before treatment and every 2 weeks at the first 2 months. RESULTS： The incidence of abnormal ALT in treatment group and control group in 2 months were 10.8% and 27.1%, respectively （P〈0.05）, there was significant difference between 2 groups （P〈0.05）. After hepatic injury occurred, the level of LPO had been improved, which had significant difference before treatment and non-liver impairer （P〈0.05） , LPO level of control group was higher than treatment group obviously （P〈0.05）. CONCLUSION： Anti-tuberculosis drug-induced hepatic injury is correlated with preoxidization of LPO. Taking Reduced glutathione can obviously decrease the generation of LPO and the incidence of hepatic injury.