恩替卡韦联合抗结核药物治疗肺结核合并慢性乙型肝炎患者的临床效果

Clinical Effect of Entecavir Combined with Anti Tuberculosis Drugs in the Treatment of Pulmonary Tuberculosis Patients with Chronic Hepatitis B

目的 研究恩替卡韦和抗结核药物联合治疗肺结核合并慢性乙型肝炎患者的效果以及对结核分枝杆菌转阴率的影响。方法将2019年3月至2021年3月于宁德市蕉城区医院就诊的65例肺结核合并慢性乙型肝炎的患者随机分为对照组33例和干预组32例,对照组采用抗结核药物利福平、异烟肼、吡嗪酰胺和乙胺丁醇常规四联疗法进行治疗,干预组采用同样的抗结核药物常规四联疗法并联合恩替卡韦进行治疗,分析比较两组患者用药后的结核分枝杆菌转阴率、临床肝功能指标ALT、AST以及用药后的不良反应情况。结果 在治疗后的6周,干预组患者结核分枝杆菌转阴率显著高于对照组,差异有统计学意义,P <0.05。在治疗后的4周和6周时,干预组患者的丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)水平显著低于对照组,二者差异有统计学意义,P <0.05。干预组不良反应总发生率显著低于对照组,两组对比差异有统计学意义,P <0.05。结论 恩替卡韦和抗结核药物联合应用治疗肺结核合并慢性乙型肝炎可以提升结核分枝杆菌转阴率,提升治疗效果;同时药物联合应用可以降低患者肝脏的损害并改善肝功能,用药后不良反应发生较少,应用安全性高。

Objective To study the effect of entecavir combined with anti tuberculosis drugs in the treatment of patients with pulmonary tuberculosis complicated with chronic hepatitis B and its influence on the negative rate of Mycobacterium tuberculosis.Methods Sixty-five patients with pulmonary tuberculosis complicated with chronic hepatitis B who were hospitalized in our hospital from March 2019 to March 2021 were randomly divided into the control group(33 cases)and the intervention group(32 cases).The control group was treated with rifampicin,isoniazid,pyrazinamide and ethambutol,and the intervention group was treated with the same anti tuberculous drugs combined with entecavir,The negative conversion rate of Mycobacterium tuberculosis,clinical liver function indexes alt,AST and adverse reactions were analyzed and compared between the two groups.Results At 6 weeks after treatment,the negative conversion rate of Mycobacterium tuberculosis in the intervention group was significantly higher than that in the control group(P<0.05).At 4 and 6 weeks after treatment,the levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the intervention group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the intervention group was significantly lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).Conclusion The combined application of entecavir and anti tuberculosis drugs in the treatment of pulmonary tuberculosis complicated with chronic hepatitis B can improve the negative rate of mycobacterium tuberculosis and improve the treatment effect.At the same time,the combined use of drugs can reduce the damage of patients'liver and improve the liver function.The adverse reactions after drug use are less and the application safety is high.