慢性肝病伴结核病时化疗方案的选择及肝损害的防治对策

The choice of chemotherapy on hepatic disease cases with tuberculosis and the method to protect hepatic from damage

目的探讨慢性肝病伴结核病时化疗方案的选择及肝损害的防治对策。方法170例慢性肝病伴结核病的患者在化疗前常规的作肝功能检测,并根据临床类型及其程度选择不同的化疗方案。对乙肝病毒复制指标阳性伴肝炎活动的患者进行抗病毒治疗。结果肝损害的发生率或恶化率慢性HBV携带者<酒精性肝病、脂肪性肝病<慢性肝炎轻度<慢性肝炎中度<慢性肝炎重度、肝硬化(P<0.01);抗病毒治疗的乙型肝炎肝损害的加重或恶化率低于非抗病毒治疗组(P<0.05);综合疗法与单纯化疗者肝损害好转与恶化的发生率和结核病的转归之间有明显的差异(P<0.01)。结论对于慢性肝病伴结核病的患者,化疗前要做好肝功能状况的评估工作,并依据肝病的临床类型及其程度选择合适的化疗方案,对肝损明显及某些特殊群体要加强抗炎、护肝、免疫、增强等措施,伴HBV复制的活动性乙肝同时进行抗病毒治疗。

Objective To observe the choice of chemotherapy on hepatic disease cases with tuberculosis and to explore the method to protect hepatic from damage. Method The study was undertaken by evaluating and appraising 170 chronic hepatic disease cases with tuberculosis patients hepatic function before taking chemotherapy. According to the different types and degrees of the chronic hepatic disease, different types of chemotherapy were chosen. If the index of HBV reproducing was positive, the patients were treated by resisting virus. Results The degree of liver damage was identified in a ascending order as following： No symptom and carrier of HBV, alcoholic hepatic disease, low level chronic hepatic disease, middle level chronic hepatic disease, high level chronic hepatic disease, and hepatic hardening （ P 〈 0.01 ）. The use of anti - virus had better treatment effects than not using it （ P 〈 0. 05 ）. The improvement rates were different between those who had comprehensive treatment plan and those who had simple chemotherapy alone （P 〈 0. 01 ）. Conclusion For the patients with chronic hepatic disease with tuberculosis, it is important to have liver function evaluated before taking chemotherapy. Choice of chemotherapy should be made based on clinical characteristics of liver diseases and the degree of damaged already done. For those with severe liver damage or special group of patients, measures and actions should be taken including anti -bacteria, liver protection, immunity, enhancement and strengthening. Anti - virus treatment can also be given for those with index of HBV reproducing being positive.