2HLZE/4HLE与2HRZE/4HRE抗结核方案在初治菌阳肺结核伴有乙肝患者肝损害中的应用效果

Comparison of 2HLZE/4HLE and 2HRZE/4HRE Anti-tuberculosis Regimens for Liver Tuberculosis in Patients with Hepatitis B

目的对比2HLZE/4HLE与2HRZE/4HRE抗结核方案在初治菌阳肺结核伴有乙肝患者肝损害中的应用效果。方法采用回顾性研究方法,选择2015年7月-2017年4月在我院诊治的初治菌阳肺结核伴有乙肝患者94例,根据治疗方法的不同分为观察组(利福喷丁) 47例与对照组(利福平) 47例,对照组给予2HRZE/4HRE抗结核方案治疗,观察组给予2HLZE/4HLE抗结核方案治疗,治疗观察3个月,记录肝损害发生情况。结果治疗后观察组与对照组的显效率分别为93.6%和78.7%,观察组显著高于对照组(P<0.05)。治疗后观察组与对照组的痰菌阴转率分别为97.8%和87.2%,观察组高于对照组(P<0.05)。观察组与对照组治疗期间的肝损害发生率分别为8.5%和27.7%,观察组低于对照组(P<0.05)。治疗后两组的血清谷丙转氨酶(ALT)、血清谷草转氨酶(AST)水平均低于治疗前(P<0.05),观察组低于对照组(P<0.05)。结论含利福喷丁的抗结核治疗方案在初治菌阳肺结核伴有乙肝患者中的应用能降低肝损害,促进恢复肝功能,提高痰菌阴转率与总体治疗效果。

Objective To compare the applicability of 2HLZE/ 4HLE and 2HRZE/ 4HRE anti-tuberculosis regimens inthe treatment of liver tuberculosis in patients with hepatitis B infection. Methods A retrospective study was conductd among 94patients with newly diagnosed pulmonary tuberculosis complicated with hepatitis B who were treated in our hospital between July2015 and April 2017. These patients were equally divided into the observation group （rifapentine） and the control group （rifampicin） according to treatment methods. The control group received the 2HRZE/ 4HRE anti-tuberculosis regimen, while the observation group was treated with the 2HLZE/ 4HLE anti-tuberculosis regimen. The treatment lasted 3 months, and the incidenceof liver damage was recorded. Results The effective rates of the treatment group and the control group were 93. 6% and 78. 7%,respectively, which were significantly higher in the treatment group than in the control group （P〈0. 05）. After treatment, therates of sputum negative conversion of the treatment group and the control group were 97. 8% and 87. 2%, respectively, and theywere higher in the treatment group than in the control group （P〈0. 05）. The incidence of liver damage in the treatment group andthe control group was 8. 5% and 27. 7%, respectively. The levels of serum alanine aminotransferase （ALT） and serum aspartateaminotransferase （AST） in the two groups were lower after treatment （P〈0. 05）, especially in the treatment group （P〈0. 05）.Conclusion Anti-tuberculosis treatment with rifapentine in patients with newly diagnosed pulmonary tuberculosis complicatedwith hepatitis B can reduce liver damage, promote liver function recovery, and improve the rate of sputum negative conversionand overall treatment.