拉米夫定的不同用法在HBV感染结核病的临床应用研究

Clinical study on the efficacy of lamivudine in the treatment of HBV infection with tuberculosis

目的探讨拉米夫定的不同用法在HBV感染结核病的临床应用价值。方法采用前瞻性研究方法,选择2011年8月至2015年11月在我院进行诊治的190例HBV感染结核病患者,根据入院顺序分为观察组与对照组,每组95例,对照组给予拉米夫定联合阿德福韦酯治疗,观察组给予拉米夫定序贯阿德福韦酯治疗,治疗观察6个月。结果观察组治疗有效率(88.4%)高于对照组(72.6%),两组比较差异有统计学意义(P<0.05)。治疗后,观察组ALT、AST、TBIL、DBIL低于对照组(P<0.05),观察组HBV-DNA、HbeAg转阴率(91.6%、81.1%)高于对照组(74.7%、68.4%),两组比较差异有统计学意义(P<0.05)。结论相对于联合疗法,拉米夫定序贯阿德福韦酯疗法在HBV感染结核病的治疗中能减轻肝脏损伤,提高HBV-DNA、HbeAg转阴率及结核患者的治疗有效率。

Objective To explore the clinical value of different usages of lamivudine in the treatment of hepatitis B virus（HBV） infection with tuberculosis.Methods One hundred and ninety patients of HBV infection with tuberculosis in our hospital from August 2011 to November 2015 were selected by using a prospective study method.All the patients were equally divided into two groups according to the order of admission,95 cases in each group.Control group received adefovir dipivoxil combined with lamivudine treatment,and observation group received lamivudine and adefovir dipivoxil sequential therapy,the treatment lasting for 6 months.Results The effective rate of observation group was higher than that of control group（88.4%vs.72.6%,P〈0.05）.The levels of ALT,AST,TBIL and DBIL in observation group were lower than those of control group after treatment（P〈0.05）,while the negative rates of HBV-DNA and HBeAg in observation group（91.6% and 81.1%） were higher than those of control group（74.7% and 68.4%）,there being significant differences（P〈0.05）.Conclusion Compared with combination therapy,lamivudine and adefovir dipivoxil sequential therapy can significantly relieve the liver injury,and improve the negative rates of HBV-DNA and HBeAg and the effective rate in the treatment of HBV infection with tuberculosis.