预防性抗病毒在肺结核合并慢性乙型肝炎病毒携带者中的应用价值

Application value of preventive antiviral therapy in patients with pulmonary tuberculosis complicated with Chronic HBV carriers

目的 探讨采用恩替卡韦预防性抗病毒结合2HREZ/4HR标准化疗方案治疗在肺结核(pulmonary tuberculosis,PTB)合并慢性乙型肝炎病毒(hepatitis B virus,HBV)携带者中的应用价值。方法 选取湖北省宜昌市夷陵医院2016年3月—2021年1月收治的80例PTB合并慢性HBV携带患者,采取掷硬币法分为对照组和暴露组,各40例。对照组采用2HREZ/4HR标准化疗方案治疗,暴露组在对照组基础上采用恩替卡韦预防性抗病毒治疗,比较2组患者的治疗效果。结果 暴露组治疗总有效率为95.00%,高于对照组的72.50%,差异有统计学意义(P<0.05)。治疗后,暴露组药物性肝损伤发生率低于对照组,且发生药物性肝损伤的患者中暴露组天门冬氨酸转氨酶(aspartate aminotransferase,AST)、丙氨酸转氨酶(alanine a minotransferase,ALT)、总胆红素(total bilirubin,TBIL)、总胆汁酸(total bile acids,TBA)水平均低于对照组,差异均有统计学意义(P<0.05)。治疗2个月后,暴露组血清乙肝病毒的脱氧核糖核酸(HBV-deoxyribonucleic acid,HBV-DNA)水平较对照组低,差异有统计学意义(P<0.05)。暴露组肺结核复治率7.50%低于对照组的25.00%,病死率0%低于对照组的10.00%,不良反应发生率5.00%低于对照组的25.00%,差异均有统计学意义(P<0.05)。结论 PTB合并慢性HBV携带患者采用恩替卡韦预防性抗病毒结合2HREZ/4HR标准化疗方案治疗,效果确切,可显著减轻肝损伤,降低肺结核中断治疗的发生率,肺结核复治率较低,有较高的安全性。

Objective To explore the application value of entecavir prophylactic antiviral combined with 2HREZ/4HR standard chemotherapy in patients with pulmonary tuberculosis(PTB)complicated with hepatitis B virus(HBV).Methods From March 2018 to January 2021,80 cases of PTB patients with HBV carriers were selected and divided into control group and observation group by coin tossing method,40 cases in each group.The control group was treated with 2HREZ/4HR regimen,while the exposure group was treated with entecavir prophylactic antiviral therapy.Results The effective rate of the observation group was 95.00%,higher than 72.50%of the control group,the difference was significant(P<0.05).After treatment,the drug-induced liver damage in the exposure group was significantly lower than that in the control group(P<0.05),and the indexes of AST,ALT,TBIL and TBA in the exposure group were significantly lower than those in the control group(P<0.05).At the end of 2 months,the level of hepatitis B virus DNA(HBV-DNA)in the exposed group decreased significantly,and the negative conversion rate of HBV-DNA was significantly higher than that in the control group(P<0.05).The recurrence rate of the observation group was 7.50%,lower than 25.00%of the control group,the mortality rate was 0%,lower than 10.00%of the control group,the incidence of adverse reactions was 5.00%,lower than 25.00%of the control group,the difference was significant(P<0.05).Conclusion Patients with PTB complicated with HBV carriers are treated with enteka prophylactic antiviral combined with 2HREZ/4HR standard chemotherapy,which has definite effect,can significantly reduce liver damage and reduce the proportion of interrupted treatment of tuberculosis.The retreatment rate of tuberculosis is low and has high safety.