CAJ | 학술논문

目的评估恩替卡韦对慢性HBV感染合并肺结核患者抗结核治疗中肝损伤的防治效果.方法连续收集2011年1月至2012年5月广州市第八人民医院及广州市胸科医院慢性HBV感染合并初治肺结核患者102例.所有病例分为3组:A组33例,采用恩替卡韦联合抗结核治疗；B组29例,采用拉米夫定联合抗结核治疗；C组40例,为单纯抗结核治疗组.观察3组患者肝损伤、中止治疗发生率以及治疗前后肝功能和HBV DNA的变化情况.采用SPSS 13.0软件进行统计学分析.结果 A组2例(6.1％),B组6例(20.6％),C组22例(55.0％)出现肝损伤,3组间肝损伤发生率比较差异有统计学意义(x2=22.126,P＜0.01),但A组与B组的肝损伤发生率比较差异无统计学意义(x2=3.024,P＞0.05).A组1例(3.0％),B组3例(10.3％),C组15例(37.5％)在观察期间中止抗结核治疗,3组中止治疗发生率差异有统计学意义(x2=16.008,P＜0.01),但A组与B组之间的差异无统计学意义(x2=1.410,P＞0.05).A组和B组患者接受抗结核治疗前后肝功能均无明显变化,C组接受抗结核治疗后ALT、AST水平均较A组和B组明显升高(Z=18.306,16.821,P＜0.01).治疗前3组间HBV DNA水平差异无统计学意义(Z=0.460,P＞0.05),治疗后A组与B组的HBV DNA水平明显下降,3组间比较差异有统计学意义(Z =23.213,P＜0.01).其中,治疗1个月后,A组病毒载量较B组下降明显(Z =8.109,P＜0.01).结论早期使用恩替卡韦抗病毒治疗可明显减少慢性HBV感染合并肺结核患者抗结核治疗过程中肝损伤的发生,确保抗结核治疗与抗HBV治疗顺利进行.
목적 평고은체잡위대만성HBV감염합병폐결핵환자항결핵치료중간손상적방치효과.방법 련속수집2011년1월지2012년5월엄주시제팔인민의원급엄주시흉과의원만성HBV감염합병초치폐결핵환자102례.소유병례분위3조:A조33례,채용은체잡위연합항결핵치료；B조29례,채용랍미부정연합항결핵치료；C조40례,위단순항결핵치료조.관찰3조환자간손상、중지치료발생솔이급치료전후간공능화HBV DNA적변화정황.채용SPSS 13.0연건진행통계학분석.결과 A조2례(6.1％),B조6례(20.6％),C조22례(55.0％)출현간손상,3조간간손상발생솔비교차이유통계학의의(x2=22.126,P＜0.01),단A조여B조적간손상발생솔비교차이무통계학의의(x2=3.024,P＞0.05).A조1례(3.0％),B조3례(10.3％),C조15례(37.5％)재관찰기간중지항결핵치료,3조중지치료발생솔차이유통계학의의(x2=16.008,P＜0.01),단A조여B조지간적차이무통계학의의(x2=1.410,P＞0.05).A조화B조환자접수항결핵치료전후간공능균무명현변화,C조접수항결핵치료후ALT、AST수평균교A조화B조명현승고(Z=18.306,16.821,P＜0.01).치료전3조간HBV DNA수평차이무통계학의의(Z=0.460,P＞0.05),치료후A조여B조적HBV DNA수평명현하강,3조간비교차이유통계학의의(Z =23.213,P＜0.01).기중,치료1개월후,A조병독재량교B조하강명현(Z =8.109,P＜0.01).결론 조기사용은체잡위항병독치료가명현감소만성HBV감염합병폐결핵환자항결핵치료과정중간손상적발생,학보항결핵치료여항HBV치료순리진행.
Objective To evaluate the preventive effect of entecavir on liver injury in chronic HBV infected patients complicated with tuberculosis receiving anti-tuberculosis treatment.Methods A total of 102 chronic HBV infected patients complicated with tuberculosis were collected from Guangzhou Eighth People' s Hospital and Guangzhou Chest Hospital during January 2011 and May 2012.Patients were divided into three groups:group A (n =33) received entecavir plus anti-tuberculosis treatment,group B (n =29) received lamivudine plus anti-tuberculosis treatment,and group C (n =40) received anti-tuberculosis treatment only.Liver injury,termination of treatment,liver function and HBV DNA load before and after treatment were observed.SPSS 13.0 was used for statistial analysis.Results Two cases (6.1％) in group A,6 cases (20.6％) in group B and 22 cases (55.0％) in group C had liver injury,and the difference among three groups was of statistical difference (x2 =22.126,P ＜ 0.01),but the difference between group A and group B was not significant (x2 =3.024,P＞0.05).One case (3.0％) in group A,3 cases (10.3％) in group B and 15 cases (37.5％) in group C terminated the treatment,and the difference among three groups was of statistical significance (x2 =16.008,P ＜ 0.01),but the difference between group A and group B was not significant (x2 =1.410,P ＞0.05).ALT and AST in group A and group B were not of significant differences before and after anti-tuberculosis treatment,but those in group C were significantly higher (Z =18.306,16.821,P ＜ 0.01).There was no significant difference in HBV DNA load among three groups before the treatment (Z =0.460,P ＞ 0.05),while HBV DNA loads in group A and group B significantly decreased during the treatment,and the difference among three groups after the treatment was significant (Z =23.213,P ＜0.01).In addition,lower HBV DNA load was observed in group A compared with group B after one month anti-tuberculosis treatment (Z =8.109,P ＜ 0.01).Conclusion Early use of entecavir can effectively prevent liver injury during anti-tuberculosis treatment,ensuring anti-tuberculosis treatment and anti-HBV treatment carried out as planned.