替比夫定在慢性HBV感染合并肺结核患者抗结核治疗中减轻肝损害的临床观察

目的 观察替比夫定在HBV DNA阳性慢性HBV感染合并肺结核患者抗结核治疗过程中减轻肝损害的作用.方法 选择2011年6月至2013年12月武汉市黄陂区人民医院收治的HBV DNA阳性慢性HBV感染合并肺结核患者68例.按数字表法将所有患者随机分为2组,联合治疗组（35例）在抗结核治疗的同时给予替比夫定抗病毒治疗,单纯抗结核治疗组（33例）仅接受抗结核治疗.采用x2检验或秩和检验比较两组患者接受抗结核治疗后肝损害的发生率、调整或中止抗结核治疗率及HBV再激活率.结果 联合治疗组有5例（5/35,14.29％）患者发生肝损害,而单纯抗结核治疗组有15例（15/33,45.45％）患者发生肝损害,两组比较差异有统计学意义（x2=7.95,P＜0.05）.联合治疗组有1例（1/35,2.86％）调整抗结核治疗方案,而单纯抗结核治疗组有13例（13/33,39.39％）调整或中止抗结核治疗,两组比较差异有统计学意义（x2=13.87,P＜0.01）.联合治疗组有2例（2/35,5.71％）患者发生HBV再激活,而单纯抗结核治疗组有10例（10/33,30.30％）患者发生HBV再激活,两组HBV再激活率比较差异也有统计学意义（x2=7.34,P＜0.01）.结论 替比夫定在HBV DNA阳性慢性HBV感染合并肺结核患者抗结核治疗中减轻肝损害有一定的作用.

Telbivudine alleviates liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with chronic HBV infections

Objective To investigate the alleviation effect of telbivudine on liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with HBV DNA positive chronic HBV infection.Methods A total of 68 pulmonary tuberculosis patients with HBV DNA positive chronic HBV infection were enrolled from Huangpi People＇ s Hospital during June 2011 and December 2013.Patients were randomly assigned to receive antitubercular plus telbivudine treatment （combination group,n =35） or antitubercular treatment only （single group,n =33）.Chi-square and rank sum tests were performed to compare the incidence of liver damages,adjustment or termination of antitubercular treatment,and HBV reactivations between two groups.Results Liver damage was observed in 5 patients （5/35,14.29%） of combination group and in 15 patients （15/33,45.45%） of single group （x2 =7.95,P 〈 0.05）.One patient （1/35,2.86%） in combination group adjusted the therapy,while 13 patients （13/33,39.39%） in single group adjusted or terminated treatment （x2 =13.87,P 〈0.01）.HBV reactivation occurred in 2 patients （2/35,5.71%） of combination group,but in 10 patients （10/33,30.30%） of single group （x2 =7.34,P 〈 0.01）.Conclusion Telbivudine can effectively alleviate liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with HBV DNA positive chronic HBV infections.