探讨硫普罗宁联合拉米夫定治疗肺结核合并慢性乙型肝炎患者的临床疗效

Discussion on clinical efficacy of tiopronin combined with lamivudine in the treatment of patients with pulmonary tuberculosis and chronic hepatitis B

目的探讨硫普罗宁联合拉米夫定治疗肺结核合并慢性乙型肝炎患者的临床疗效。方法 90例肺结核合并慢性乙型肝炎患者,采用双盲法分为A组、B组、C组,各30例。所有患者均采用常规抗结核、保肝治疗,B组在此基础上增加拉米夫定治疗,C组在B组基础上增加硫普罗宁治疗,比较三组的治疗效果。结果三组患者治疗前丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及总胆红素(TBIL)水平比较,差异无统计学意义(P>0.05)。A组治疗后ALT、AST及TBIL水平较治疗前明显升高,差异有统计学意义(P<0.05);B组治疗前后ALT、AST及TBIL水平比较,差异无统计学意义(P>0.05);C组治疗后ALT、AST及TBIL水平较治疗前明显降低,差异有统计学意义(P<0.05)。C组治疗后ALT、AST及TBIL水平明显低于B组和A组,B组治疗后ALT、AST及TBIL水平明显低于A组,差异均有统计学意义(P<0.05)。A组、B组和C组的治疗总有效率分别为60.00%、76.67%和96.67%,C组总有效率明显优于A组和B组,差异有统计学意义(P<0.05)。结论硫普罗宁联合拉米夫定治疗肺结核合并慢性乙型肝炎患者能够有效降低抗结核药物对肝功能的损伤,有利于治疗的顺利进行,疗效显著,值得应用。

Objective To discuss the clinical efficacy of tiopronin combined with lamivudine in the treatment of patients with pulmonary tuberculosis and chronic hepatitis B. Methods A total of 90 patients with pulmonary tuberculosis and chronic hepatitis B were divided by double-blind method into group A, group B and group C, with 30 cases in each group. All patients received conventional anti-tuberculosis and liver preservation treatment, and group B also received lamivudine treatment. Group C received tiopronin on the basis of group B. The treatment effect in three groups was compared. Results Three groups had no statistically significant difference in alanine aminotransferase（ALT）, aspartate aminotransferase（AST） and total bilirubin（TBIL） before treatment（P〈0.05）. After treatment, group A had obviously higher ALT, AST and TBIL level than before treatment, and the difference was statistically significant（P〈0.05）. Group B had no statistically significant difference in ALT, AST and TBIL level before and after treatment（P〈0.05）. Group C had obviously lower ALT, AST and TBIL level after treatment than before treatment, and their difference was statistically significant（P〈0.05）. Group C had obviously lower ALT, AST and TBIL level after treatment than group B and group A, and group B had obviously lower ALT, AST and TBIL level after treatment than group A. Their difference was statistically significant（P〈0.05）. Group A, group B and group C had total treatment effective rate respectively as 60.00%, 76.67% and 96.67%, and group C had obviously better total effective rate than group A and group B. Their difference was statistically significant（P〈0.05）. Conclusion Combination of tiopronin and lamivudine shows remarkable efficacy in treating patients with pulmonary tuberculosis combined with chronic hepatitis B, and can effectively reduce the damage of liver function caused by anti tuberculosis drugs. It is conducive to the smooth progress of treatment, and is worthy of application.