恩替卡韦治疗肺结核合并乙型肝炎病毒携带者41例临床疗效分析

Clinical curative effect of entecavir in tuberculosis patients with HBV carriers

目的 观察抗结核的同时给予恩替卡韦抗病毒治疗对乙型肝炎病毒（HBV）携带者肺结核患者的临床疗效.方法 85例HBV携带者合并肺结核患者予2（HRZE）/4（HR）抗结核治疗,其中41例患者（治疗组）同时接受恩替卡韦抗病毒治疗,另44例患者作为对照组,治疗6个月后观察患者肝功能损害情况.结果 治疗结束时,治疗组肝功能指标[ALT（45.1±3.5）U/L,AST（40.1±5.5）U/L,TBIL（22.9±3.6） μmol/L]明显低于对照组[ALT（78.2±8.6） U/L,AST（70.1±9.3）U/L,TBIL（35.1±5.7） μmol/L],血清HBV DNA复制也明显受到抑制,治疗组HBV DNA为（3.5±0.5）log10 copies/ml,对照组为（6.2±2.4） log10 copies/ml.治疗组因肝功能损害停止抗结核治疗者1例（2.4％）,对照组6例（13.6％）.结论 抗结核治疗过程中给予恩替卡韦抗病毒治疗对防治肝炎发作有明显保护作用.

Objective To observe the clinical efficacy of antituberculosis therapy with antiviral treatment in tuberculosis patients with HBV carriers.Methods Eighty-five cases of tuberculosis with HBV carriers received 2 （HRZE）/4 （HR）antituberculosis therapy,and they were randomly divided into two groups：41 cases received entecavir as additional antiviral therapy （treatment group）,while the other 44 cases only received antituberculosis therapy （control group）.The liver function in both groups were investigated after six months of the treatment.Results At the end of the treatment,the levels of liver function in the treatment group were significantly lower than those in the control group[ALT（45.1 ± 3.5） U/L vs.（78.2 ± 8.6） U/L,AST （40.1 ± 5.5） U/L vs.（70.1 ± 9.3） U/L,TBIL （22.9 ± 3.6） μmol/L vs.（35.1 ±5.7）μmol/L],as well as the serological level of the HBV DNA replication （3.5 ± 0.5）log10copies/ml vs.（6.2 ± 2.4） log10 copies/ml.1 case （2.4％） in the treatment group was discontinued from the therapy due to liver dysfunction,which was significantly lower than that of 6 cases（13.6％） in the control group.Conclusion Treatment of anti-tuberculosis combined with antiviral （entecavir） has a significant protective effect on prevention and treatment of hepatitis.