恩替卡韦对高病毒量HBV感染并肺结核患者肝损害的临床疗效

目的：观察恩替卡韦对伴有高病毒载量的慢性HBV感染合并肺结核患者抗结核治疗中肝损害的疗效。方法将77例伴有高病毒载量的慢性HBV感染合并肺结核患者分为3组并均给予2HRZS（E）/4HR方案抗结核治疗。其中A组（22例）在化疗前2周给予恩替卡韦抗病毒治疗，B组（25例）在化疗开始时同时给予恩替卡韦抗病毒治疗，C组（30例）仅接受抗结核治疗。观察3组患者接受化疗后的肝损害发生率、终止治疗率及治疗前后肝功能、HBV DNA变化。结果 A组及B组患者总肝损害及终止治疗率均较C组显著降低（χ2=34.268、18.015，P均＜0.05），其中A组均为0%，而B组则分别为24%和12%。C组完成抗结核治疗患者ALT、AST水平较治疗前（Z=-4.906及-4.862，P＜0.05）以及较治疗后的A组（Z=-5.302、-5.814，P＜0.05）和B组显著升高（Z=-5.298与-5.299，P＜0.05）。治疗后A组和B组患者的HBV DNA均显著下降，但A组患者HBV DNA在化疗1个月后较B组稍低（Z=57.640，P＜0.05）。结论化疗前提前给予恩替卡韦可进一步降低伴有高病毒载量患者化疗后的肝损害，从而确保患者抗结核治疗长期、有效、顺利进行。

Effects of entecavir on liver dysfunction in tuberculosis patients coinfected with HBV and high HBVDNA load

Objective To investigate the effects of entecavir on liver dysfunction in tuberculosis patients coinfected with HBV and high HBV DNA load under anti-tuberculosis treatment. Methods Total of 77 tuberculosis patients coinfected with HBV in high HBV DNA load were enrolled and divided into three groups, all of whom received anti-tuberculosis treatment of 2HRZS（E）/4HR. Goup A （22 cases） received entecavir for two weeks before chemotherapy, while group B （25 cases） received entecavir simultaneously with chemotherapy from the beginning, group C （30 cases） only received anti-tuberculosis treatment. The incidences of liver dysfunction and discontinuing treatment after chemotherapy were investigated. The changing levels of ALT, AST and HBV DNA were also detected before and after chemotherapy. Results The incidences of liver dysfunction and discontinuing treatment were both significantly lower in group A and B than in group C （χ2=34.268, 18.015;all P〈0.05） , group A were both 0%, while group B were 24%and 12%, respectively. After chemotherapy, groups C had higher levels of ALT and AST than before chemotherapy （Z=-4.906,-4.862;P〈0.05） and higher than that in groups A （Z=-5.302,-5.814;P〈0.05） and B （Z=-5.298,-5.299;P〈0.05） after chemotherapy. HBV DNA level in both group A and group B decreased signiifcantly after therapy, while group A had lower level than group B in 1 month after chemotherapy （Z=57.640, P〈0.05）. Conclusions Administration of entecavir preemptively is effective in preventing liver dysfunction in tuberculosis patients coinfected with HBV in high DNA load under chemotherapy, and it will ensure a long-term, effective and successful anti-tuberculosis treatment.