拉米夫定预防乙型肝炎病毒携带者抗结核治疗致肝损伤的临床疗效  

Observation of clinical efficacy of preventing liver injury of lamivudine on hepatitis B virus carriers with anti-tuberculosis drugs

作　　者：赵勇华[1] 于建武[1] 李树臣[1] 

机构地区：[1]哈尔滨医科大学附属第二医院感染病科,150086

出　　处：《中华传染病杂志》2007年第5期303-306,共4页Chinese Journal of Infectious Diseases

摘　　要：目的评估拉米夫定预防HBV携带者服用抗结核药物致肝损伤的临床疗效。方法110例服用抗结核药物的HBV携带者随机分为拉米夫定组和对照组。拉米夫定组55例,服用异烟肼、利福平、吡嗪酰胺、链霉素或乙胺丁醇6～8个月,同时给予拉米夫定100 mg,每天1次口服;对照组55例,服用与拉米夫定组相同的抗结核药物6～8个月。评价治疗前后患者临床症状、肝功能及HBV DNA,数据采用t检验和x^2检验。结果拉米夫定组肝损伤发生率为9.1%;而对照组为38.2%(P<0.01);拉米夫定组临床症状和肝功能明显好于对照组(P<0.01);治疗结束时,拉米夫定组患者HBV DNA为(3.1±0.3)lg拷贝/mL,对照组为(6.3±0.7)lg拷贝/mL;随访1年期间,两组间肝炎发病率比较差异无统计学意义(P>0.05)。结论拉米夫定可能减少HBV携带者服用抗结核药物所导致的肝损伤,安全性好。Objective To evaluate the clinical efficacy of lamivudine in preventing liver injury induced by anti-tuberculosis drugs in hepatitis B virus（HBV） carriers. Methods One hundred and ten HBV carriers treated with anti-tuberculosis drugs were randomly divided into lamivudine group and control group. Patients in both groups were treated with conventional anti-tuberculosis drugs （isoniazid, rifampicin, pyrazinamide, streptomycin or ethambutol） for 6-8 months. However, patients in lamivudine group were treated with lamivudine 100 mg orally daily concomitantly. Before and after treatment, the clinical manifestation, liver function and serum HBV DNA level of patients were evaluated. Statistical analysis was performed using t test and X^2 test. Results During 6-8 months of treatment, the incidence rate of liver injury was 9.1% in lamivudine group, while it was 38.2% in control group（P 〈 0. 01）. Clinical symptoms and liver function of the patients in lamivudine group were better than those in control group（P 〈 0.01）. When the therapy was completed, the serum HBV DNA level was （3. 1±0.3）lg copy/mL in lamivudine group and （6.3±0.7）lg copy/mL in e6ntrol group. In 1-year follow-up period, there was no statistical difference of hepatitis flare rate between lamivudine group and control group（P 〉 0.05）. Conclusion Lamivudine is effective and safe in reducing liver injury induced by anti-tuberculosis drugs in HBV carriers.

关 键 词：拉米夫定 肝炎病毒 乙型 结核 肺 

分 类 号：R512.62[医药卫生—内科学]