阿德福韦酯对肺结核并慢性乙型肝炎患者的作用及意义

Effect of adefovir dipivoxil on pulmonary tuberculous complicated with chronic hepatitis B

目的观察阿德福韦酯对肺结核并慢性乙型肝炎(CHB)患者作用。方法标准化疗的39例肺结核并CHB患者,随机分成阿德福韦酯抗病毒治疗组20例,对照组19例。两组患者均随访至3.5年。观察肺结核并CHB患者化疗中,阿德福韦酯抗病毒治疗与肝功能变化以及患者预后的相关性。结果化疗中,肺结核并CHB抗病毒组,肺结核并CHB未抗病毒组,肺结核并HBV-DNA阴性、其它HBV-M阳性组,单纯肺结核组,肝功能受损率分别为33.33%,94.74%,10.00%及5.07%。随访至3.5年,肺结核并CHB未抗病毒组,死亡7例(36.84%),且死亡与肝病直接相关(肝衰竭),发生肝硬化3例;肺结核并CHB抗病毒组,无肝硬化及死亡病例。结论肺结核并CHB,化疗中应用阿德福韦酯抗病毒有重要意义。阿德福韦酯抗HBV治疗,对改善肺结核CHB患者预后有重要作用,并有CHB的肺结核患者,建议化疗中常规联用阿德福韦酯抗HBV治疗。

Objective To observe the effects of adefovir dipivoxil in treatment of pulmonary tuberculous complicated with chronic hepatitis B （CHB）. Methods There 39 pulmonary tubercalosis cases complicated with CHB were divided into two groups randomly,20 patients in treatment group and treated with adefovir dipivoxil, 10 rag/day, 19 patients in control group and treated without adefovir diivoxil .The patients were followed up for 3.5 years. Results In the course of antitubereulous chemotherapy ,the abnormal Liver function rate turned to be 94.74% in the control group but only 33.33% in the treatment group （P〈0.01）.The abnormal liver function rate turned to be 94.74% in the control group but only 10.00% and 5.07% in the negafives,HBV-DNA group and pulmonary tuberculosis group （P〈0.01 ,P〈0.01 ） respectively.The presence of HBV-DNA in patients with pulmonary tuberculosis was associated with high mortality rate and the cause of death was related to hepatic failure. Conclusion The effect of adefovir dipivoxil is effective for treatment of pulmonary tuberculous cases complicated with CHB.