肺结核合并HBV感染的优化治疗

Optimized treatment of pulmonary tuberculosis complicated with HBV infection

目的探讨在肺结核合并HBV感染的抗痨治疗中,依据HBV-DNA检测结果,选择性抗病毒治疗的优越性和不足。方法肺结核合并HBV感染患者117例,其中HBV-DNA阳性组51例(抗痨起始时联用拉米夫定,为A组)、HBV-DNA阴性组66例(抗痨后监测HBV-DNA,若HBV-DNA阳转,则加用拉米夫定,为B组);对照组为121例HBsAg阴性的肺结核患者,为C组;上述三组均给予"2HRZE/4HR"方案抗痨,同时密切监测肝功能和HBV-DNA。结果 A、B、C三组的肝损害率分别为:21.6%、15.2%和5.8%;三组抗痨中断率分别为:5.9%、3.0%和0.8%;三组病例均无肝损害相关性死亡发生。A、B组的肝损害率及A组的抗痨中断率与C组对比差异均有统计学意义。B组在抗痨全过程中始终保持HBV-DNA阴性者有54例,与C组对比在肝损害率及抗痨中断率方面差异均无统计学意义。结论依据HBV-DNA检测结果,选择性抗病毒治疗,能有效降低抗痨时的肝损害,并能避免大部分HBV-DNA阴性时不必要的抗病毒治疗。但HBV感染时行抗痨,抗病毒治疗并不能最大程度地避免肝损害的发生。

Aim To discuss the treatment of pulmonary tuberculosis cases complicated with HBV infection. Methods The 117 patients were divided into Group A consisted of 51 HBV-DNA positives treated with anti-tuberculosis and lamivudine; Group B consisted of 66 HBV -DNA negatives treated with anti-tuberculosis while monitoring the HBV-DNA conversion and if positive for HBV-DNA ,then lamivudine wuld added,Grou C consisted of 121 tuberculosis cases as controls and all negative for HBsAg. Meatime 2HRZE/4HR regimens was used for anti-tuberculosis treatment. During treatment the liver function and HBV-DNA conversion of the cases were closely monitored. Results The liver lesions in Goups A, B and C were 21.6%, 15.2% and 5.8%; the anti-tuberculosis discontinuation rates in the three groups were 5.9%, 3.0% and 0.8%. The liver damage rate in Group A and B compared to Group C were significant heavily ,and the interruption rate of anti-tuberculosis treatment in Group A group compared with the C group were significantly was significant higher. Conclusions Selective treatment of tuberculosis patients complicated with HBV infection based on the HBV-DNA test results can efectvely reduce the liver damage.