中国临床药学杂志

目的 比较抗炎保肝药物不同联用方案治疗病毒性肝炎的有效性及安全性，为临床病毒性肝炎治疗方案的制定提供参考。方法 收集2016年6月至2022年12月使用抗炎保肝药物治疗病毒性肝炎的住院病例503例，根据药物联用方案分为单药组（n=65）、双联组（n=160）、3联组（n=225）和4联组（n=53）。比较4组疗效、治疗前后谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、总胆红素（TBIL）和白蛋白（ALB）水平，以及不良反应发生情况。结果 肝胆外科（占51.1%）及感染科（占46.1%）使用抗炎保肝药物较多。503例病例使用抗炎保肝药物的用药天数为（10.08±5.26）d，感染科使用抗炎保肝药物的用药天数长于肝胆外科（P <0.01）。抗炎保肝药物主要联用方案为3联（占44.7%）。抗炎保肝药物治疗病毒性肝炎的有效率为65.6%。肝胆外科双联组、3联组和4联组的有效率均低于单药组（P <0.01），感染科单药组有效率低于其他3组（P <0.01）。双联组治疗前AST和ALT水平高于单药组（P <0.05）,3联组治疗前ALT、AST和TBIL水平高于单药组（P <0.01）,4联组ALT、AST和ALP水平高于单药组（P <0.01）。治疗后双联组、3联组和4联组的ALT和AST水平低于治疗前（P <0.05）。使用注射用复方甘草酸苷发生不良反应的病例占比（50.0%）最高。结论 临床使用抗炎保肝药物治疗病毒性肝炎的方案以3联用药为主，肝胆外科和感染科使用抗炎保肝药物较多。对于肝功能较差的患者，临床倾向于选择多种药物联合使用方案，但多种药物联合使用可能会进一步影响患者肝功能。建议临床用药过程中权衡治疗方案的安全性与有效性，控制药物使用数量，减轻患者肝脏负担，降低不良反应发生风险。

AIM To investigate the efficacy and safety of different combinations of hepatoprotective drugs in treating viral hepatitis, providing reference for formulating therapeutic regimens for viral hepatitis. METHODS A total of 503 patients with viral hepatitis who received hepatoprotective drugs from June 2016 to December 2022 were collected.Patients were divided into single-drug, double-drug, triple-drug and quadruple-drug treatment groups based on the combination regimen. Levels of ALT, AST, ALP, TBIL and ALB before and after treatment, the effective rate of treatment and the occurrence of adverse reactions were compared among 4 groups. RESULTS The use of anti-inflammatory and hepatoprotective drugs was higher in the department of hepatobiliary surgery(51.1%) and infectious diseases(46.1%).The average treatment course was(10.08±5.26) days in 503 cases. The duration of anti-inflammatory and hepatoprotective drug use in the infectious diseases department was longer than that in the hepatobiliary surgery department(P<0.01).The main medication regimen was the triple-drug regimen, accounting for 44.7%. The total effective rate was 65.6%. The effective rate of the multi-drug regimen in the hepatobiliary surgery department was lower than that of the single-drug regimen(P<0.01). Conversely, in the infectious diseases department, the efficacy rate of the single-drug group was lower than the other groups(P<0.01). The levels of AST and ALT in the dual-drug group were higher than those in the singledrug group(P<0.05), the levels of ALT, AST, and TBIL in the triple-drug group were higher than those in the single-drug group(P<0.01), and the levels of ALT, AST, and ALP in the quadruple-drug group were higher than those in the singledrug group(P<0.01). The levels of ALT and AST were significantly decreased after the treatment of multi-drug regimens(P<0.05). CONCLUSION The mainstream of drug therapy for viral hepatitis is the triple-drug regimen. Hepatobiliary surgery and infectious diseases departments frequently utilize anti-inflammatory and hepatoprotective medications. For individuals with compromised liver function, clinicians prefer multi-drug regimens. However, multiple medications could potentially further affect liver function in these patients. It is recommended to weigh the safety and effectiveness of therapeutic regimens during clinical medication, control the number of drugs administered, reduce the liver burden of patients, and reduce the risk of adverse reactions.