拉米夫定对肺结核并HBV感染患者的作用分析

目的：观察拉米夫定对肺结核并HBV感染患者的作用。方法：标准化疗的41例血清HBV-DNA阳性的肺结核并HBV感染患者,随机分成拉米夫定抗病毒治疗组21例,对照组20例。治疗组用拉米夫定0.1g.d-1,对照组未用拉米夫定,疗程半年。两组患者均随访至4.3年。观察肺结核并HBV复制患者化疗中,拉米夫定抗病毒治疗与肝功能变化以及患者预后的相关性。结果：102例肺结核并HBV感染患者血清HBV-DNA阳性41例,阳性率为40.20%,化疗中,肺结核并血清HBV-DNA阳性抗病毒组,肺结核并血清HBV-DNA阳性未抗病毒组,肺结核并HBV-DNA阴性、其它HBV-M阳性组,单纯肺结核组的肝功能受损率分别为28.57%,95%,9.68%及5.07%。随访至4.3年,肺结核并血清HBV-DNA阳性,未抗病毒组,死亡4例（20%）,且死亡与肝病直接相关（肝衰竭）,发生肝硬化2例;肺结核并血清HBV-DNA阳性抗病毒组,无肝硬化及死亡病例。结论：肺结核并HBV感染,且HBV复制,化疗中应用拉米夫定有重要意义。拉米夫定抗HBV治疗,对改善存在HBV复制的肺结核患者预后有重要作用,并有HBV感染的肺结核患者,化疗前可常规检查血清HBV-DNA。血清HBV-DNA阳性的肺结核患者,建议化疗中常规联用拉米夫定抗HBV治疗。

Efficacy of Lamivudine for Pulmonary Tuberculosis Complicated with Hepatitis B Virus Infection

OBJECTIVE：To observe the efficacy of Lamivudine in treating pulmonary tuberculosis complicated with hepatitis B virus（HBV） infection.METHODS：41 patients with pulmonary tuberculosis complicated with HBV infection receiving standard chemotherapy were divided into two groups randomly：21 cases（treatment group） received Lamivudine 0.1 g·d-1 while 20 patients（control group） received no Lamivudine.The course of treatment was half a year and the two groups were given follow-up of 4.3 years.The correlation between Lamivudine antiviral therapy and change of liver function and patients＇ prognosis were observed.RESULTS：Of the total 102 patients with pulmonary tuberculosis complicated with hepatitis B virus（HBV） infection,41（40.20%） were positive for serum HBV-DNA.In the course of chemotherapy,the liver function lesion was noted in 28.57% of the patients with pulmonary tuberculosis and positive HBV-DNA antiviral therapy,95% of those with pulmonary tuberculosis and positive HBV-DNA but received no antiviral therapy）,9.68% of those with pulmonary tuberculosis and negative HBV-DNA but positive HBV-M） and 5.07% of those with simple pulmonary tuberculosis.At 4.3 years of follow-up,for patients with pulmonary tuberculosis and positive HBV-DNA who received no antiviral therapy,4（20%） death cases were noted,and the death was directly associated with the liver disease（hepatic failure）,and 2 developed cirrhosis;however,in antiviral therapy group,neither cirrhosis nor death was noted.CONCLUSION：Lamivudine used concomitantly with chemotherapy is of great importance for patients with pulmonary tuberculosis complicated with hepatitis B virus（HBV） infection and HBV duplication.As an anti-HBV therapy,Lamivudine has remarkable efficacy in improving the prognosis for patients with pulmonary tuberculosis and HBV duplication.For patients with pulmonary tuberculosis complicated with hepatitis B virus（HBV） infection,routine examination of HBV-DNA should be done prior to chemotherapy.For patients with pulmonary tuberculosis with positive serum HBV-DNA,it is advisable to routinely use Lamivudine（antiviral therapy） in addition to chemotherapy.