恩替卡韦对肺结核并HBV感染者的作用及意义(1)

http://www.100md.com 2019年2月5日 《中国医学创新》 2019年第4期

     【摘要】 目的：探讨肺结核合并HBV感染患者采用恩替卡韦治疗的临床效果。方法：选取2017年1-12月本院收治的单纯肺结核患者100例为A组，浸润型肺结核并HBV感染初次治疗者39例为B组(按照治疗方法不同将其分为对照组19例、观察组20例)。患者均接受抗结核治疗，且观察组联合口服恩替卡韦，而对照组未服用恩替卡韦。比较观察组和对照组治疗前后的肝功能水平(AST、ALT、TBil);比较肺结核患者肝功能受损、中断治疗情况;对观察组和对照组进行6个月的追踪访视，观察有无死亡及肝硬化情况。结果：治疗后，观察组ALT、AST水平均优于对照组(P<0.05)，但两组TBil水平比较差异无统计学意义(P>0.05);对照组肝功能受损率、中断治疗率均高于观察组、A组(P<0.05);对照组化疗后6个月内发生肝硬化2例，观察组无死亡或并发肝硬化，比较差异无统计学意义(P>0.05)。结论：临床上给予肺结核合并HBV感染患者恩替卡韦治疗可以减轻肝功能损伤。

    【关键词】 HBV感染; 肺结核; 恩替卡韦

    【Abstract】 Objective：To explore the clinical effect of Entecavir in treatment of pulmonary tuberculosis with HBV infection.Method：A total of 100 patients with simple pulmonary tuberculosis admitted to our hospital from January to December 2017 were selected as A group，39 patients with invasive pulmonary tuberculosis and primary treatment of HBV infection as B group(according to different treatment methods，they were divided into 19 cases of control group and 20 cases of observation group).They received anti-tuberculosis treatment，the observation group combined with oral Entecavir，while control group did not take Entecavir.The levels of liver function(AST，ALT，TBil)before and after treatment were compared between observation group and control group，the impairment of liver function and interruption of treatment in patients with pulmonary tuberculosis were compared，observation group and control group were followed up for 6 months to observe the death and cirrhosis.Result：After treatment，the levels of ALT and AST in observation group were better than those of control group(P<0.05)，but TBil levels in two groups was compared，the difference was not statistically significant(P>0.05).The liver function damage rate and interruption treatment rate in control group were higher than those of observation group and A group(P<0.05).The cirrhosis occurred 2 cases within 6 months after chemotherapy in control group，and no death or cirrhosis was found in observation group，the difference was not statistically significant(P>0.05).Conclusion：Entecavir treatment for pulmonary tuberculosis patients with HBV infection can alleviate liver function damage.

    【Key words】 HBV infection; Tuberculosis; Entecavir

    First-author’s address：Central Hospital of Longgang，Shenzhen 518000，China

    doi：10.3969/j.issn.1674-4985.2019.04.029

    結核病作为一种慢性感染性疾病，其发生与感染结核分枝杆菌有关，其中比较常见的是肺结核，而乙肝病毒(HBV)感染能够诱发多种疾病如肝癌、乙肝肝硬化以及乙型肝炎携带等，严重危害患者健康。有研究发现，结核菌/HBV双重感染能够导致肺结核合并乙型肝炎，是比较严重的一个合并症，并且HBV诱发肝炎，不仅不利于肺结核化疗的顺利进行，也是出现耐药菌株的一个重要因素，使化疗失败，严重情况，甚至危及患者生命安全[1]。当前在治疗肝病时，通常以抗病毒为主，但是在肺结核治疗中，抗结核化疗是比较重要的一个环节，除链霉素外，其他化疗药物均会损伤肝脏，诱发药物性肝炎，所以选择一种合适的治疗药物尤为重要[2]。因此，本文对恩替卡韦运用在肺结核并HBV感染治疗中的临床价值进行了探讨，现报道如下。(陈润柱 徐风 刘秀丽 刘素娟 罗晓芳)

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