CAJ | 학술논문

目的：观察恩替卡韦对伴有高病毒载量的慢性HBV感染合并肺结核患者抗结核治疗中肝损害的疗效。方法将77例伴有高病毒载量的慢性HBV感染合并肺结核患者分为3组并均给予2HRZS（E）/4HR方案抗结核治疗。其中A组（22例）在化疗前2周给予恩替卡韦抗病毒治疗，B组（25例）在化疗开始时同时给予恩替卡韦抗病毒治疗，C组（30例）仅接受抗结核治疗。观察3组患者接受化疗后的肝损害发生率、终止治疗率及治疗前后肝功能、HBV DNA变化。结果 A组及B组患者总肝损害及终止治疗率均较C组显著降低（χ2=34.268、18.015，P均＜0.05），其中A组均为0%，而B组则分别为24%和12%。C组完成抗结核治疗患者ALT、AST水平较治疗前（Z=-4.906及-4.862，P＜0.05）以及较治疗后的A组（Z=-5.302、-5.814，P＜0.05）和B组显著升高（Z=-5.298与-5.299，P＜0.05）。治疗后A组和B组患者的HBV DNA均显著下降，但A组患者HBV DNA在化疗1个月后较B组稍低（Z=57.640，P＜0.05）。结论化疗前提前给予恩替卡韦可进一步降低伴有高病毒载量患者化疗后的肝损害，从而确保患者抗结核治疗长期、有效、顺利进行。
목적：관찰은체잡위대반유고병독재량적만성HBV감염합병폐결핵환자항결핵치료중간손해적료효。방법장77례반유고병독재량적만성HBV감염합병폐결핵환자분위3조병균급여2HRZS（E）/4HR방안항결핵치료。기중A조（22례）재화료전2주급여은체잡위항병독치료，B조（25례）재화료개시시동시급여은체잡위항병독치료，C조（30례）부접수항결핵치료。관찰3조환자접수화료후적간손해발생솔、종지치료솔급치료전후간공능、HBV DNA변화。결과 A조급B조환자총간손해급종지치료솔균교C조현저강저（χ2=34.268、18.015，P균＜0.05），기중A조균위0%，이B조칙분별위24%화12%。C조완성항결핵치료환자ALT、AST수평교치료전（Z=-4.906급-4.862，P＜0.05）이급교치료후적A조（Z=-5.302、-5.814，P＜0.05）화B조현저승고（Z=-5.298여-5.299，P＜0.05）。치료후A조화B조환자적HBV DNA균현저하강，단A조환자HBV DNA재화료1개월후교B조초저（Z=57.640，P＜0.05）。결론화료전제전급여은체잡위가진일보강저반유고병독재량환자화료후적간손해，종이학보환자항결핵치료장기、유효、순리진행。
Objective To investigate the effects of entecavir on liver dysfunction in tuberculosis patients coinfected with HBV and high HBV DNA load under anti-tuberculosis treatment. Methods Total of 77 tuberculosis patients coinfected with HBV in high HBV DNA load were enrolled and divided into three groups, all of whom received anti-tuberculosis treatment of 2HRZS(E)/4HR. Goup A (22 cases) received entecavir for two weeks before chemotherapy, while group B (25 cases) received entecavir simultaneously with chemotherapy from the beginning, group C (30 cases) only received anti-tuberculosis treatment. The incidences of liver dysfunction and discontinuing treatment after chemotherapy were investigated. The changing levels of ALT, AST and HBV DNA were also detected before and after chemotherapy. Results The incidences of liver dysfunction and discontinuing treatment were both significantly lower in group A and B than in group C (χ2=34.268, 18.015;all P<0.05) , group A were both 0%, while group B were 24%and 12%, respectively. After chemotherapy, groups C had higher levels of ALT and AST than before chemotherapy (Z=-4.906,-4.862;P<0.05) and higher than that in groups A (Z=-5.302,-5.814;P<0.05) and B (Z=-5.298,-5.299;P<0.05) after chemotherapy. HBV DNA level in both group A and group B decreased signiifcantly after therapy, while group A had lower level than group B in 1 month after chemotherapy (Z=57.640, P<0.05). Conclusions Administration of entecavir preemptively is effective in preventing liver dysfunction in tuberculosis patients coinfected with HBV in high DNA load under chemotherapy, and it will ensure a long-term, effective and successful anti-tuberculosis treatment.