恩替卡韦治疗合并肺结核的慢性HBV携带者效果观察

Clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection

目的探讨肺结核合并慢性HBV携带患者抗结核治疗的同时应用恩替卡韦治疗的临床效果。方法收集2013年1月-2015年12月南安市医院收治的108例肺结核合并慢性HBV携带者,分为恩替卡韦组(n=58)和对照组(n=50)。恩替卡韦组在给予抗结核药物治疗前1个月至抗结核治疗全程均采用恩替卡韦进行干预,对照组单纯使用抗结核药物治疗,比较2组肝损伤及临床症状的发生率、肝功能异常出现时间及肝功能恢复的时间。计量资料组间比较采用独立样本t检验,计数资料组间比较采用χ2检验。结果恩替卡韦组与对照组肝功能异常发生率(29.31%vs 64.00%)、肝损伤临床症状发生率(17.24%vs 28.00%)比较,差异均有统计学意义(χ2值分别为8.475、5.534,P值均<0.05);恩替卡韦组与对照组肝功能异常出现及恢复正常的时间分别为(25.1±10.2)d vs(20.1±8.9)d、(26.5±9.8)d vs(32.6±11.2)d,2组比较差异均有统计学意义(t值分别为2.675、3.778,P值均<0.05)。结论恩替卡韦能明显降低肺结核合并慢性HBV携带者抗结核治疗所引起的肝损伤,延缓肝损伤出现时间,并能加快肝功能的恢复。

Objective To investigate the clinical effect of entecavir combined with antituberculosis therapy in patients with tuberculosis complicated by chronic HBV infection. Methods A total of 108 patients with tuberculosis complicated by chronic HBV infection were divided into entecavir group with 58 patients and control group with 50 patients. The patients in the entecavir group were given entecavir from1 month before antituberculosis therapy to the end of antituberculosis therapy,and those in the control group were given antitubercular agent alone. The incidence of liver injury and clinical symptoms,time to appearance of abnormal liver function,and time to liver function recovery were compared between the two groups. The two- independent- samples t test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Compared with the control group,the entecavir group had significantly higher incidence rates of abnormal liver function（ 29. 31% vs 64. 00%,χ2= 8. 475,P〈0. 05） and clinical symptoms of liver injury（ 17. 24% vs 28. 00%,χ2= 5. 534,P〈0. 05）. There were significant differences in the time to appearance of abnormal liver function（ 25. 1 ± 10. 2 d vs 20. 1 ± 8. 9 d,t = 2. 675,P〈0. 05） and time to liver function recovery（ 26. 5 ± 9. 8 d vs 32. 6 ±11. 2 d,t = 3. 778,P〈0. 05）. Conclusion Entecavir can significantly reduce the incidence of liver injury caused by antituberculosis therapy,postpone the time to appearance of liver injury,and accelerate liver function recovery in patients with tuberculosis complicated by chronic HBV infection.