拉米夫定预防乙型肝炎病毒携带者合并结核性胸膜炎患者在激素治疗过程中病毒激活

Lamivudine prevent hepatitis B virus reactivation in hepatitis B virus carriers accompany with tuberculous pleurisy who need to administrate prednisone

目的探讨拉米夫定预防HBV携带者合并结核性胸膜炎患者使用泼尼松后激活HBV的价值。方法 91例HBV携带者合并结核性胸膜炎患者分为治疗组48例,对照组43例。对照组采用抗结核药物加泼尼松治疗,治疗组在对照组的基础上加用拉米夫定,100 mg/d,至泼尼松停用3个月终止。对比两组治疗前、治疗后1、2、3个月ALT、AST水平和HBV DNA的变化。结果治疗后1、2、3个月对照组ALT、AST分别为(40.3±2.8)、(60.1±4.0)、(64.5±3.8)、(30.1±3.2)、(64.2±2.7)、(62.2±4.7)U/L,均高于同期治疗组(36.6±2.0)、(38.9±5.4)、(40.1±4.2)、(20.3±1.8)、(59.5±2.3)、(50.1±3.1)U/L,均P<0.05。在治疗2、3个月后,对照组HBV DNA水平分别为(5.7±1.1)、(5.1±1.2)lg拷贝/mL显著高于治疗组(4.3±0.9)、(4.1±1.1)lg拷贝/mL,均P<0.05。对照组治疗后HBV DNA也明显高于治疗前(4.3±1.0)lg拷贝/mL,P<0.05。治疗2个月后对照组有8例HBV DNA转阳,而治疗组无1例转阳,其中4例伴有ALT、AST升高达150 U/L。结论 HBV携带者合并结核性胸膜炎患者采用抗结核及泼尼松治疗的同时加用拉米夫定,能有效预防HBV被激活,且不影响抗结核药物的疗效。

Objective To investigate the value of anti-virus drug,lamivudine,in preventing virus re-activation in hepatitis B virus （HBV）carriers accompany with tuberculous pleurisy who need to administrate prednisone.Methods Ninety-one HBV carriers accompany with tuberculous pleurisy were divided into treatment group （48 cases）and control group （43 cases）.Based on basic treatment of both groups,the treatment group received lamivudine additional. Lamivudine was orally administrated with 1 00 mg/day,and was ended up until three months after prednisone therapy completed.Hepatic function and quantity of HBV DNA were compared between two groups at the beginning of treatment and different time points during the therapy.Results The ALT and AST levels of all cases were normal at the beginning of treatment,and had no differences between two groups.The ALT and AST levels of control group were higher than that of treatment group at 1,2 and 3 months after prednisone therapy （ALT：40.3±2.8 VS 36.6±2.0,60.1±4.0 VS 38.9±5.4,64.5±3.8 VS 40.1±4.2;AST：30.1±3.2 VS 20.3±1.8,64.2±2.7 VS 59.5±2.3,62.2±4.7 VS 50.1 ±3.1）.The differences between two groups were statistically significant （P〈0.05）.The level of HBV DNA copies in control group was significantly higher than that in treatment group at 2 and 3 months after prednisone therapy （5.7±1.1 VS 4.3±0.9,5.1±1.2 VS 4.1±1.1,P〈0.05）.8 cases,which HBV DNA were undetectable at the beginning of therapy in control group,had the results of HBV DNA detectable at 2 months after prednisone therapy,4 cases,which accompanied with significant increase in AST and ALT levels received entecavir therapy.Conclusions Anti-virus drug lamivudine can effectively prevent HBV re-activation in HBV carriers accompanied with tuberculous pleurisy who need to administrate prednisone,and does not affect the outcome of tuberculous pleurisy.