2HRZE/4HR与3HESO/9HEO化疗方案治疗肺结核并慢性乙型肝炎患者临床疗效的对比研究

Comparative Study for Clinical Effect in Treating Pulmonary Tuberculosis Patients Complicated with Chronic Hepatitis B between 2HRZE/4HR and 3HESO/9HEO Chemotherapy Regimen

目的比较2HRZE/4HR与3HESO/9HEO化疗方案治疗肺结核并慢性乙型肝炎患者的临床疗效。方法选取2013年6月—2015年3月惠州市惠城区慢性病防治站收治的肺结核并慢性乙型肝炎患者70例,采用随机数字表法分为对照组与观察组,每组35例。两组患者均予以抗病毒治疗,在此基础上,对照组患者予以2HRZE/4HR化疗方案,观察组患者予以3HESO/9HEO化疗方案;两组患者均随访至治疗后第12个月。比较两组患者治疗第9个月肺部病灶吸收情况和痰菌转阴率,治疗第1个月乙型肝炎病毒(HBV)DNA转阴率,治疗前及治疗第1个月肝功能指标〔总胆红素(TBi L)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)〕,肝功能损伤情况及其损伤程度,治疗期间毒副作用/不良反应发生情况。结果治疗第9个月观察组患者肺部病灶吸收情况优于对照组(P<0.05)。观察组患者治疗第9个月痰菌转阴率、治疗第1个月HBV DNA转阴率高于对照组(P<0.05)。治疗前两组患者TBi L、ALT、AST水平比较,差异无统计学意义(P>0.05);治疗第1个月观察组患者TBi L、ALT、AST水平低于对照组(P<0.05)。观察组患者肝功能损伤发生率低于对照组(P<0.05)。两组患者肝功能损伤程度比较,差异无统计学意义(P>0.05)。观察组患者毒副作用/不良反应发生率低于对照组(P<0.05)。结论 3HESO/9HEO化疗方案治疗肺结核并慢性乙型肝炎患者的临床疗效优于2HRZE/4HR化疗方案,可更有效地改善患者临床症状,减少肝功能损伤、毒副作用/不良反应的发生,且安全性较高。

Objective To compare the clinical effect in treating pulmonary tuberculosis patients complicated with chronic hepatitis B between 2HRZE/4HR chemotherapy regimen and 3HESO/9HEO chemotherapy regimen. Methods From June 2013 to March 2015,a total of 70 pulmonary tuberculosis patients complicated with chronic hepatitis B were selected in the Station for Chronic Disease Prevention and Treatment of Huicheng District,Huizhou,and they were divided into control group and observation group according to random number table, each of 35 cases. Patients of the two groups received anti- virus treatment after admission,meanwhile patients of control group received 2HRZE/4HR chemotherapy regimen,while patients of observation group received 3HESO/9HEO chemotherapy regimen; patients of the two groups were followed up to the 12 ed month after treatment. Pulmonary lesions absorption results and sputum negative conversion rate on the ninth month of treatment,negative conversion rate of HBV DNA on the first month of treatment,index of hepatic function（ including TBi L,ALT and AST） before treatment and on the first month of treatment,incidence of hepatic injury and its degree,incidence of toxic and side effects/adverse reactions during the treatment were compared between the two groups. Results Pulmonary lesions absorption results of observation group was statistically significantly better than that of control group on the ninth month of treatment（ P 〈0. 05）. Sputum negative conversion rate on the ninth month of treatment and negative conversion rate of HBV DNA on the first month of treatment of observation group was statistically significantly higher than that of control group,respectively（ P 〈 0. 05）.No statistically significant differences of serum level of TBi L,ALT or AST was found between the two groups before treatment（ P〉 0. 05）,while serum levels of TBi L,ALT and AST of observation group were statistically significantly lower than those of control group on the first month of treatment（ P 〈 0. 05）. The incidence of hepatic injury of observation group was statistically significantly lower than that of control group（ P 〈 0. 05）. No statistically significant differences of hepatic injury degree was found between the two groups（ P 〉 0. 05）. The incidence of toxic and side effects/adverse reactions of observation group was statistically significantly lower than that of control group during the treatment（ P 〈 0. 05）. Conclusion 3HESO/9HEO chemotherapy regimen has better clinical effect than 2HRZE/4HR chemotherapy regimen in treating pulmonary tuberculosis patients complicated with chronic hepatitis B,can more effectively relive the clinical symptoms,reduce the risk of hepatic injury and toxic and side effects/adverse reactions,has relatively high safety.