恩替卡韦在肺结核合并慢性乙型肝炎患者中的治疗观察

Treatment effect of Entecavir in patients with tuberculosis and chronic hepatitis B

目的探讨使用恩替卡韦抗乙型肝炎病毒治疗对肺结核合并慢性乙型肝炎患者抗结核治疗过程中肝损伤的防治效果。方法 2012年1月—2015年6月收治的261例肺结核合并慢性乙型肝炎患者被随机分为两组。在抗结核治疗过程中,一组接受恩替卡韦抗病毒治疗,对照组未行抗病毒治疗,比较两组肝损伤和终止抗结核治疗发生率以及抗结核治疗前后肝功能和血清HBV DNA的变化情况。结果抗病毒组患者治疗后血清ALT、AST和HBV DNA分别为（35.1±4.2）U/L、（31.2±5.8）U/L和（2.6±1.0）lgcopies/m L,明显低于对照组（62.4±11.7）U/L、（60.7±9.1）U/L和（7.0±0.8）lgcopies/m L,差异有统计学意义（χ~2=20.168、χ~2=20.004和χ~2=24.602,P〈0.05）。抗病毒组治疗后终止抗结核治疗发生率为1.5%,均显著低于对照组的35.9%,差异有统计学意义（χ~2=18.021,P〈0.05）。结论在HBV DNA阳性的慢性乙型肝炎合并肺结核患者中,恩替卡韦能有效降低血清病毒载量,减少抗结核治疗过程中肝损伤的发生率,有效提高患者治疗依从性。

Objective To investigate the anti-hepatitis B virus （HBV）by entecavir （ETV）of prevention and treatment effect for liver damages of patients with tuberculosis （TB） and chronic hepatitis B （CHB） during the anti-TB therapy. Methods A total of 261 patients with TB and CHB in our hospital were divided into two groups randomly from January, 2012 to June, 2015. In anti-TB treatment, one group was treated with ETV and another one did not. The rate of liver damages, anti- rib treatment discontinued and the change of liver function and HBV-DNA before and after Anti-TB treatment were compared. Results After antiviral in treatment group,ALT ,AST and HBV-DNA were （35.1±4.2）U/L, （31.2±5.8）U/L and （2.6±1.0） lg copies/mL, respectively , and much lower than the control group [ （62.4±11.7） U/L, （60.7±9.1）U/L and （7.0±0.8） lgcopies/ mL]. There were statistically significant differences （X2=20.168,X2=20.004 and X2=24.602, P〈0.05）. The incidence rate of Anti-TB treatment discontinued was 1.5% in treatment group, and was much lower than the control group （35.9%）. There was statistically significant difference （A3=18.021, P〈0.05）.Coaclusion For patients with CHB and TB, ETV can reduce HBV- DNA, liver damages during anti-TB treatment to effectively improve patients＂ compliance.