目的 探讨五灵胶囊联合还原型谷胱甘肽治疗抗结核药物性肝损伤的临床疗效。方法 选择2023年3月—2025年9月沧州市第三医院收治的120例抗结核药物性肝损伤患者，采用随机数字表法将所有患者分为对照组和治疗组，每组各60例。对照组给予注射用还原型谷胱甘肽，5%葡萄糖注射液250 mL＋1.2 g注射用还原型谷胱甘肽静脉滴注，1次/d。治疗组在对照组治疗方案基础上口服五灵胶囊，1.0 g/次，3次/d。两组均连续治疗4周。观察两组临床疗效、症状改善时间，比较两组肝功能指标、36项简明健康调查量表（SF-36）评分、疲劳量表-14（FS-14）评分。结果 治疗后，治疗组总有效率100.00%，显著高于对照组的85.00%，差异有统计学意义（P＜0.05）。治疗过程中，治疗组乏力、纳差、恶心、黄疸改善时间均短于对照组（P＜0.05）。治疗结束时，两组血清丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、总胆红素（TBil）、γ-谷氨酰转移酶（GGT）均较治疗前下降（P＜0.05），且治疗组血清ALT、AST、TBil、GGT均低于对照组（P＜0.05）。治疗后，两组SF-36量表中生理功能评分、生理职能评分、躯体疼痛评分、总体健康评分、活力评分、社会功能评分、情感职能评分及精神健康评分均较治疗前升高（P＜0.05），且治疗组SF-36各维度评分均高于对照组（P＜0.05）。治疗后，两组FS-14量表中脑力疲劳评分、躯体疲劳评分及总分均较治疗前下降（P＜0.05），且治疗组脑力疲劳评分、躯体疲劳评分及总分均低于对照组。结论 五灵胶囊联合注射用还原型谷胱甘肽治疗抗结核药物所致肝损伤，在促进肝功能恢复、缓解临床症状、提高生活质量方面较单用还原型谷胱甘肽表现出更优的疗效，且安全性良好，具备临床推广应用价值。

Objective To observe the clinical efficacy of Wuling Capsules combined with reduced glutathione in treatment of anti-tuberculosis drug-induced liver injury. Methods A total of 120 patients with anti-tuberculosis drug-induced liver injury who were admitted to The Third Hospital of Cangzhou from March 2023 to September 2025 were selected. All patients were divided into control group and treatment group using the random number table method, with 60 patients in each group. Patients in control group were given intravenous Reduced Glutathione for injection, 250 mL of 5% glucose injection + 1.2 g of Reduced Glutathione for injection for intravenous drip, once daily. Patients in treatment group received oral Wuling Capsules on the basis of treatment plan of control group, 1.0 g/time, 3 times daily. Both groups were treated continuously for 4 weeks. The clinical efficacy, symptom improvement time of two groups were observed, and the liver function indicators, SF-36 score of the 36-item brief health survey scale, and FS-14 score of fatigue scale were compared between two groups. Results After treatment, the total effective rate of the treatment group was 100.00%, significantly higher than that of the control group (85.00%), and the difference was statistically significant (P < 0.05). During the treatment process, the improvement time of fatigue, loss of appetite, nausea, and jaundice symptoms in treatment group was shorter than that in control group (P < 0.05). At the end of the treatment, the serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and γ-glutamyl transferase (GGT) levels of both groups were lower than those before treatment (P < 0.05), and the serum ALT, AST, TBil, and GGT levels of treatment group were lower than those of control group (P < 0.05). After treatment, the scores of physiological function, physiological role, physical pain, overall health, vitality, social function, emotional role, and mental health in SF-36 scale of both groups were higher than those before treatment (P < 0.05), and the scores of each dimension of SF-36 scale in treatment group were higher than those in control group (P < 0.05). After treatment, the scores of mental fatigue, physical fatigue, and total score in FS-14 scale of both groups were lower than those before treatment (P < 0.05), and the scores of mental fatigue, physical fatigue, and total score in treatment group were lower than those in control group. Conclusion Wuling Capsules combined with Reduced Glutathione for injection in treatment of anti-tuberculosis drug-induced liver injury has better curative effect than glutathione alone in promoting liver function recovery and relieving clinical symptoms, which has good safety and possesses clinical application promotion value.

R975

河北省中医药类科学研究计划项目（2023272）