两种化疗方案对肺结核合并慢性肝病患者肝功能的影响

To elvate the liver function of patient with tuberculosis combined with chronic liver disease treated by 2HRZE/4HR and 3HESG/9HEG

目的探讨2HRZE/4HR和3HESG/9HEG两种不同化疗方案对肺结核合并慢性肝病患者肝功能的影响。方法回顾性分析2000年6月～2006年6月住院的初治肺结核合并慢性肝病并坚持了全程化疗的患者157例,采用不同化疗方案在化疗过程中发生肝功能损害的临床资料,其中以2000年6月～2004年3月间收治的采用2HRZE/4HR及疗程半年化疗方案治疗的患者109例作为对照组,以2004年4月～2006年6月间收治的采用3HESG/9HEG及疗程一年化疗方案治疗的患者48例作为观察组。结果观察组比对照组出现肝功能损害的机率小,观察组出现肝损害10例(20.8%),对照组44例(40.4%);观察组比对照组出现肝功能损害的时间晚,观察组两个月内出现肝损害7例(14.6%),对照组40例(36.7%);观察组比对照组肝损害程度轻,观察组肝损害ALT升高3倍以上4例(8.3%),对照组35例(32.1%);出现肝损害后观察组比对照组经护肝治疗后恢复的时间短,观察组10例肝损害1个月内恢复正常9例(90%),对照组44例中1个月内恢复正常20例(45.5%);观察组与对照组在化疗方案疗程结束后疗效无明显差异。结论 3HESG/9HEG针对初治肺结核合并慢性肝病患者虽然疗程较2HRZE/4HR长半年,但出现肝损害的机率小,发生时间晚,损害程度轻,恢复较快,有利于抗痨疗程的顺利完成,能起到预期的抗痨效果,是比较理想的方案。

Objective To elvate the liver function of patient with tuberculosis combined with chomic liver diseases treated by 2HRZE/4HR and 3HESG/9HEG. Methods Altogether 157 cases with tuberculosis combined with chornic liver diseases were retrospective analysed, 109 cases treated by 2HRZE/4HR from June 2000 to March 2004 were divded into control group, and 48 cases treated by 3HESG/9HEG from June 2004 to June 2006 , as treated group. Results Compared to the control, the rate of hver function damage in treat group was lower （ 20.8% to 40.4% ） ; the emerged time was later, the rate of liver function damage emerged in two month was 14.6% and 36.7% respectively;the degree was lighter that the rate of ALT araised 3 times was 8.3% to 32.1% ; and it cost shorter time to improved liver function which rate of liver function recovercd to normal in one month was 90% to 45.5% ;At the end of treat, there were no significient difference in the efficacy between the two groups. Conclusion As the results showed , although it take six mouths long than 2HRZE/4HR, 3HESG/ 9HEG was effective and ensuring the success of the whole process of antituberculosis chemotherapy, should be approached extensively in chnieal practice.