慢性乙型肝炎合并肺结核患者不同化疗方案的临床研究

Clinical studies on different chemotherapy regimens in chronic hepatitis B patients with tuberculosis

目的观察两种不同的化疗方案治疗慢性乙型肝炎合并肺结核患者的疗效及对肝功能的影响,为慢性乙型肝炎合并肺结核患者选择治疗方案提供依据。方法将68例合并慢性乙型肝炎肺结核患者随机分为A、B两组,A组采用标准抗结核治疗方案(2HRZS3(E)/4HR)治疗36例,B组采用含左氧氟沙星方案(2HZE,LVFX/7HE,LVFX)治疗32例。观察两组疗程完成情况、x线胸片病灶显著吸收率、痰菌阴转率、肝功能等情况。结果 A组和B组退组率分别为:38.9%(14/36)、11.9%(5/42)(χ2=4.64,P<0.05);2月末痰菌阴转率和X线胸片病灶显著吸收率分别为63.6%(14/22)、86.7%(26/30)(χ2=0.51,P>0.05);54.5%(12/22)、73.3%(22/30)(χ2=0.42,P>0.05);A组和B组肝损害发生率分别为58.3%(21/36)、15.6%(5/32)(χ2=6.10,P<0.05)。结论 A、B两组方案治疗慢性乙肝合并肺结核患者疗效差异无统计学意义,但B组退组率低、肝功能损害的发生率低,患者易坚持耐受,有较好的安全性。

Objective To observe the curative effect and effects on liver function of two kinds of different chemotherapy regimens in chronic hepatitis B patients with tuberculosis, and offer evidence for choosing treatment schemes. Methods 68 chronic hepatitis B patients with tuberculosis were randomly divided into group A and group B; treatment of 36 cases in group A used standard anti-tb treatment （2HRZS3 （E）/4HR） ; treatment of 32 cases in group B used anti-tb treatment including levofloxacin （2HZE, LVFX/THE, LVFX）. After treatment, X-ray chest films, the sputum negative rate and the liver function of the patient were measured and compared between two groups. Results The dropout rates of group A and group B were 38.9%（14/36）and 11.9%（5/42）（x2=4.64,P〈0.05）,respectively.The sputum conversion rates after treated for 2 months were 63.6% （ 14/22 ） and 86.7% （26/30） （ x2=0.51, P〉0.05 ）, respectively.The significant absorption rates of X-ray chest films were 54.5% （12/22） and 73.3% （22/30） （X2=0.42, P〉0.05）, respectively. And the ineidenee of liver damage of group A and group B were 58.3%（21/36） and 15.6%（5/32）（X2=6.10,P〈0.05）, respectively. Conclusion There were no remarkable differences in curative effect between the two groups. However, the dropout rate and the incidence of liver damage in group B were lower than those in group A, which means that the treatment in group B has good security and is relatively easy for patients to tolerate.