恩替卡韦减轻肺结核合并乙型肝炎患者抗结核药肝损害的临床观察

目的探讨恩替卡韦对减轻肺结核并乙型肝炎患者抗结核药肝损害的作用。方法提前干预及与抗结核药物同步治疗及单纯抗结核药物治疗3组对比观察。结果 3组患者中,提前干预组发生肝损害发生率为10.7%(3/28),同步治疗组发生率为18.2%(6/33),单纯抗结核组发生率为51.4%(18/35),3组间差异具有统计学意义(χ2=15.215,P<0.01)。3组患者两两比较发现,提前干预组和同步治疗组肝损害发生率均明显低于单纯抗结核组(χ2=11.604,P<0.01;χ2=8.221,P<0.01),但提前干预组与同步治疗组肝损害发生率差异无统计学意义(χ2=0.000,P>0.05)。单纯抗结核组临床症状及肝损害发生率高,其肝功能恢复时间长且部分患者无法完成抗结核治疗。结论提前干预及与抗结核药物同步治疗对比单纯抗结核药物治疗,提前干预组肝损害发生率低,化疗完成率高,建议对肺结核患者合并乙型肝炎者提前使用恩替卡韦再进行抗结核治疗。

Clinical observation on entecavir to reduce liver damage of pulmonary tuberculosis patients withhepatitis B after administration of anti-tuberculosis medications

Objective To evaluate the treatment outcomes of entecavir reducing liver damage of pulmonary tuberculosis patients with hepatitis B after administration of anti-tuberculosis medications. Methods All pulmonary TB patients were randomly divided into three groups. The group received 0.5 mg entecavir before anti-TB treatment （group A）. The group received 0.5 mg entecavir together with anti-TB treatment （group B）. The group received simple anti-TB treatment （group C）, the liver damage of patients in the three groups after treatment were observed. Results The group A had 3 cases who had liver damage, the incidence rate was 10.7% （3/28）. The group B had 6 cases, the incidence rate was 18.2% （6/33）. The group C had 18 cases, the incidence rate was 51.4% （18/35）. The difference of the three groups was statistically significant （χ 2 = 15.215,P 〈 0.01）. In Comparison between two groups, the incidence rate of liver damage of the first two groups （the group A and the group B） was significantly lower than that of the group C （χ 2 =11.604,P 〈 0.01;χ 2 = 8.221,P 〈 0.01）, but the group A and the group B had no statistical difference （χ 2= 0.000,P 〉 0.05） in the incidence rate of liver damage. The patients of the group C had a high incidence rate of clinical symptoms and liver damage and needed a long time to recover liver function, even some patients can not complete the anti-TB treatment. Conclusions Entecavir therapy can improve TB treatment success among pulmonary tuberculosis patients with hepatitis B. Therefore we recommend that the pulmonary tuberculosis patients with hepatitis B use entecavir for prophylaxis before receiving anti-TB therapy.