CAJ | 학술논문

目的评价抗结核同时给予阿德福韦酯治疗慢性乙型肝炎合并肺结核的临床疗效.方法将2006年9月至2008年9月在我院接受抗结核药物治疗的慢性乙型肝炎患者94例,按照肺部结核病灶情况、肝功能损害程度和乙肝病毒定量指标,以同等病情匹配的原则分为治疗组和对照组,治疗组47例,应用异烟肼、利福喷汀、吡嗪酰胺、链霉素或乙胺丁醇及常规保肝药物,同时给予阿德福韦酯10mg口服,每日1次,疗程8个月.对照组47例应用与治疗组同样的抗结核及保肝药物,治疗8个月.评价治疗前后患者临床症状、肝功能、HBV DNA水平、痰菌转阴及肺部病灶吸收情况,采用U和χ2检验对数据做统计学处理.结果治疗后治疗组肝损伤加重者3例(占6.4%),对照组18例(占47.3%),两者差异有统计学意义;治疗后治疗组临床症状出现率、HBV DNA转阴率、HBV DNA下降率、痰菌转阴率及肺部病灶吸收率均明显好于对照组,分别为6.4%与47.3%、51.1%与0.0%、48.9%与2.6%、87.2%与39.5%及95.7%与50.0%(P<0.05).治疗前后两组肾功能检测均正常,治疗过程中或治疗结束时未发现HBV变异耐药病例.未发现使用阿德福韦酯有明显不良反应.结论阿德福韦酯可以减少慢性乙型肝炎合并肺结核患者应用抗结核药物引起的肝损伤,安全性良好.
목적 평개항결핵동시급여아덕복위지치료만성을형간염합병폐결핵적림상료효.방법 장2006년9월지2008년9월재아원접수항결핵약물치료적만성을형간염환자94례,안조폐부결핵병조정황、간공능손해정도화을간병독정량지표,이동등병정필배적원칙분위치료조화대조조,치료조47례,응용이연정、리복분정、필진선알、련매소혹을알정순급상규보간약물,동시급여아덕복위지10mg구복,매일1차,료정8개월.대조조47례응용여치료조동양적항결핵급보간약물,치료8개월.평개치료전후환자림상증상、간공능、HBV DNA수평、담균전음급폐부병조흡수정황,채용U화χ2검험대수거주통계학처리.결과 치료후치료조간손상가중자3례(점6.4%),대조조18례(점47.3%),량자차이유통계학의의;치료후치료조림상증상출현솔、HBV DNA전음솔、HBV DNA하강솔、담균전음솔급폐부병조흡수솔균명현호우대조조,분별위6.4%여47.3%、51.1%여0.0%、48.9%여2.6%、87.2%여39.5%급95.7%여50.0%(P<0.05).치료전후량조신공능검측균정상,치료과정중혹치료결속시미발현HBV변이내약병례.미발현사용아덕복위지유명현불량반응.결론 아덕복위지가이감소만성을형간염합병폐결핵환자응용항결핵약물인기적간손상,안전성량호.
Objective It is purposed to evaluate clinical efficacy of adefovir dipivoxil combined with anti-tuberculosis (TB) drugs in treatment for chronic hepatitis B (HB) complicated with pulmonary TB. Methods Ninety-four eases of pulmonary TB complicated with chronic HB receiving anti-TB drug treatment at Liaocheng Hospital for Infectious Disease during September 2006 to September 2008 were divided into treatment and control groups matched on their pulmonary TB lesion, damage in liver function and HB virus (HBV) DNA load. Forty-seven cases in the treatment group were administered with anti-TB drugs, i.e., isoniazid (INH) 0. 3 g daily, rifapentine (RFT) 0.45 g twice a week, pyrazinamide (PZA) 1.5 g daily, streptomycin (SM) 0. 75 g daily or ethambutol (EMB) 0. 75 g daily, and regular liver-protection drags, as well as oral adefovir dipivoxil 10 mg daily for eight months, and another 47 cases in the control group were administered with the same anti-TB drugs and regular liver-protection drugs as the treatment group. Two to eight weeks after treatment, clinical symptoms, liver function, HBV DNA load, negative conversion of acid-fast staining bacteria in sputum smear, and absorption of pulmonary TB lesion were evaluated for all the patients in both groups. Data were analyzed with U-test and χ2-test, respectively. Results After treatment, damage in liver function worsened in three cases (6.4%), as compared to that in 47.3 percent of the control group (P<0.05). Clinical symptoms, including tiredness, loss of appetite, abdominal distension, uncomfortable in upper abdomen, and so on, appeared in three cases of the treatment group (6.4%) during anti-TB treatment, as compared to those in 18 cases of the control group (47.3%) (P<0.05). HBV DNA conversed to negative (less than 1.0×103 lg copies/ml) in 24 cases of the treatment group (51.1%), HBV load went down to 1.0×103-1.0×104 lg copies/ml in 23 cases (48. 9%), sputum smear bacteria conversed to negative in 41 cases (87. 2%) and pulmonary lesion absorbed in 45 cases (95.7%), all with statistically significance as compared to those in the control group (47. 3% , 0. 0% , 2. 6% , 39. 5% and 50. 0% , respectively, P <0. 05). Renal function was all in normal in both groups and no patient with drug resistant variant HBV was found during and after treatment, and no obviously adverse reaction was found in patients with adefovir dipivoxil. Conclusion Adefovir dipivoxil has a good safety and can reduce laver damage in anfi-TB drug treatment for patients of chronic hepatitis B complicated with pulmonary TB.