不同治疗方案对肺结核合并乙型肝炎患者治疗效果的前瞻性队列研究

A prospective cohort study on the efficacy of different treatment regimens in patients with chronic hepatitis B complicated with pulmonary tuberculosis

目的探讨不同治疗方案对肺结核合并乙型肝炎患者的治疗效果及安全性,为选择治疗方案提供参考依据。方法采用前瞻性队列研究,选取温岭市第一人民医院2016年1月—2017年1月收治的肺结核合并乙型肝炎患者126例,按照随机数字表法将患者随机分为A(对照)组、B(拉米夫定)组和C(恩替卡韦)组,每组各42例,按不同治疗方案连续治疗6个月,观察3组患者治疗后的肝功能、HBV DNA转阴率、肺结核疗效和不良反应发生情况等,数据采用SPSS 21. 0统计学软件进行统计分析。结果治疗6个月后,B、C组的谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBIL)水平明显低于A组(P <0. 05),C组的ALT及TBIL水平低于B组(P <0. 05),C组的胸部病灶吸收率及HBV DNA转阴率高于A组(P <0. 05),B、C组的总不良反应发生率低于A组(P <0. 05)。结论抗结核治疗方案联合拉米夫定和恩替卡韦对减少抗结核药物的肝损伤、保护肝功能方面具有一定优势,在肝功能趋于正常的前提下,可能更有利于发挥抗结核药物的治疗效果,恩替卡韦组治疗的患者肝功能及HBV DNA阴转率等指标优于拉米夫定,两种药物的安全性在可接受范围内。

Objective To explore the efficacy and safety of different treatment regimens in patients with pulmonary tuberculosis combined with hepatitis B, and to provides an objective evidence for the choice of treatment regimens. Methods A prospective cohort study was used to select 126 patients of tuberculosis combined with hepatitis B in our hospital from January, 2016 to January, 2017, according to the random number table, the subjects were randomly divided into A （control） group, B （lamivudine group） and C （entente Cave） group, 42 cases in each group for 6 months ac- cording to different treatments, the liver function, HBV DNA negative conversion rate, the effect of pulmonary tuberculosis and the occurrence of adverse reactions were observed in all groups, and the data were analyzed by SPSS 21.0 statistics software. Results After 6 months of treatment, the level of ALT, AST and TBIL in group B and C was significantly lower than that in group A （ P 〈 0.05 ）. The ALT and TBIL levels of C group were lower than that of B group （ P 〈 0.05 ）. The absorption of chest lesions and the rate of HBV DNA turned negative conversion rate in group C were significantly higher than those in the A group （ P 〈 0.05 ） , the incidence of total adverse reactions in group B and C was lower than that in group A （ P 〈 0.05 ）. Conclusion The anti-tuberculosis regimen combined with lamivudine and entecavir has a certain advantage in reducing the liver damage and protecting the liver function of anti-tuberculosis drugs. It may be more beneficial to the treatment effect of anti-tuberculosis drugs on the premise of normal liver function. The indexes of liver function and HBV DNA negative conversion rate in entecavir group were better than those in lamivudine group, and the safety of the two drugs is acceptable.