替比夫定抗乙肝病毒治疗对乙肝携带者抗结核治疗肝损害的预防作用

目的观察替比夫定对乙肝携带者抗结核治疗中肝损害的预防治疗疗效。方法收集我院乙肝携带并有肺结核患者(A组)30例,及未进行抗病毒治疗的乙肝携带并有肺结核患者(B组)25例,两组开始抗结核时均采用2HRES/7HR化疗方案。A组给予水飞蓟宾护肝治疗和替比夫定抗病毒治疗;B组仅给予水飞蓟宾护肝治疗。观察两组治疗前后肝功能及HBV DNA变化情况。结果 A组治疗中不良事件发生率明显低于B组(P<0.05)。治疗前A、B两组肝功能与HBV DNA水平差异无统计学意义(P<0.05)。A组治疗后HBV DNA(log)水平为(3.68±1.04),与治疗前的(6.74±2.27)及治疗后B组的(6.57±2.54)比较差异有统计学意义(P<0.05)。B组治疗后肝功能ALT、AST增高,与治疗前及治疗后A组比较差异有统计学意义(P<0.05)。结论乙肝携带合并肺结核患者使用替比夫定抗病毒治疗可以有效抑制患者体内HBV的复制,预防肝功能损害,可以支持化疗顺利进行。

Preventive efficacy of Telbivudine on liver dysfunction in hepatitis B carriers with anti-tuberculosis treatment

Objective To evaluate the efficacy of Telbivudine in preventing liver dysfunction in hepatitis B carriers with anti-tuberculosis treatment. Methods Research group (group A) included 30 cases of hepatitis B carriers with pulmonary tuberculosis. Control group (group B) included 25 cases of hepatitis B carriers with pulmonary tuberculosis, but without receiving anti-virus therapy. Both group A and B were given with anti-tuberculosis drugs (2HRES/7HR) at the beginning of the study. In addition, group A was given with Silibinin to protect the liver function and Telbivudine for the anti-hepatitis B treatment. Silibinin was only given to group B. Rifampicin was replaced with Rifapentine in several cases with severe liver dysfunction during treatment. The change of liver function and HBV DNA level were observed before and after chemotherapy. Results The ratio of adverse events in groups A was much less than that in group B (P<0.05). No obvious different in the liver functions between group A and B before therapy (P<0.05). A significant decrease in HBV DNA level was found after chemotherapy in group A(P<0.05). ALT and AST were increased in group B after chemotherapy, and the results were statistically significant different from those before and after therapy in group A (P<0.05). Conclusion Telbivudine is effective in suppressing duplication of HBV DNA and preventing liver dysfunction in hepatitis B carriers with anti-tuberculosis therapy.