苦参素、拉米夫定在肺结核合并慢性HBV感染者抗结核化疗中的临床观察

Clinical observation of kushenin,Lamivudine to patients withpulmonary tuberculous complicated with chronic hepatitis B

目的:探讨苦参素、拉米夫定在肺结核合并慢性HBV感染者抗结核化疗过程中对肝功能的保护作用。方法:将肺结核合并HBV感染者82例随机分3组,采用标准的抗结核化疗方案2HREZ/4HR,实验组分别苦参素、拉米夫定口服,治疗期间每月检查肝功能,第3月及疗程结束时检查乙肝三对和HBV-DNA定量。结果:对照组在治疗过程中肝损率为45.0%,而苦参素组和拉米夫定组分别为15.6%,10.0%,比较差异有统计学意义(P﹤0.05);苦参素组和拉米夫定组肝损率比较无统计学意义(P>0.05);苦参素组、拉米夫定组、对照组分别有8例、19例、1例HBVDNA转阴,两两比较皆有统计学意义(P<0.05);苦参素组和拉米夫定组分别有5例和7例HBeAg/抗-HBe血清学转换,两组比较差异无统计学意义(P>0.05)。结论:肺结核合并慢性HBV感染者抗结核治疗时,加用苦参素或拉米夫定可减少抗痨过程中肝损的发生。

Objective:To approach the efficacy of kushenin,Lamivudine on liver function in patients who infected pulmonary tuberculosis complicated with chronic hepatitis B.Methods:82 cases of patients who infected pulmonary tuberculosis complicated with chronic hepatitis B are separated into three groups(control group,kushenin group,Lamivudine group),observe liver function,HBV-DNA.Results:The incidence rate of liver injury was 45.0 % in control group,while it was 15.6 % in kushenin group and 10.0% in Lamivudine group(P < 0.05);In effect of HBV-DNA negative conversion in three groups,Lamivudine group was the highest(63.3%),compared with control group,kushenin group(5.0% and 25.0%,respectively);in serum switching rate of HBeAg/ HBeAb,Lamivudine group was 23.3%,compared with kushenin group 15.6%,(P>0.05).Conclusion:kushenin or Lamivudine is effective in reducing liver injury induced by antituberculosis drugs in chronic hepatitis.