替比夫定在慢性HBV感染合并肺结核患者抗结核治疗中减轻肝损害的临床观察  

Telbivudine alleviates liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with chronic HBV infections

作　　者：胡启江[1] 徐美华[1] 汪亮[1] 侯光华[1] 杜祥兵[1] 张鸿[1] 李敏[1] 汪慧兰[1] 

机构地区：[1]武汉市黄陂区人民医院感染科,430300

出　　处：《中华临床感染病杂志》2014年第3期235-238,共4页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的 观察替比夫定在HBV DNA阳性慢性HBV感染合并肺结核患者抗结核治疗过程中减轻肝损害的作用.方法 选择2011年6月至2013年12月武汉市黄陂区人民医院收治的HBV DNA阳性慢性HBV感染合并肺结核患者68例.按数字表法将所有患者随机分为2组,联合治疗组（35例）在抗结核治疗的同时给予替比夫定抗病毒治疗,单纯抗结核治疗组（33例）仅接受抗结核治疗.采用x2检验或秩和检验比较两组患者接受抗结核治疗后肝损害的发生率、调整或中止抗结核治疗率及HBV再激活率.结果 联合治疗组有5例（5/35,14.29％）患者发生肝损害,而单纯抗结核治疗组有15例（15/33,45.45％）患者发生肝损害,两组比较差异有统计学意义（x2=7.95,P＜0.05）.联合治疗组有1例（1/35,2.86％）调整抗结核治疗方案,而单纯抗结核治疗组有13例（13/33,39.39％）调整或中止抗结核治疗,两组比较差异有统计学意义（x2=13.87,P＜0.01）.联合治疗组有2例（2/35,5.71％）患者发生HBV再激活,而单纯抗结核治疗组有10例（10/33,30.30％）患者发生HBV再激活,两组HBV再激活率比较差异也有统计学意义（x2=7.34,P＜0.01）.结论 替比夫定在HBV DNA阳性慢性HBV感染合并肺结核患者抗结核治疗中减轻肝损害有一定的作用.Objective To investigate the alleviation effect of telbivudine on liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with HBV DNA positive chronic HBV infection.Methods A total of 68 pulmonary tuberculosis patients with HBV DNA positive chronic HBV infection were enrolled from Huangpi People＇ s Hospital during June 2011 and December 2013.Patients were randomly assigned to receive antitubercular plus telbivudine treatment （combination group,n =35） or antitubercular treatment only （single group,n =33）.Chi-square and rank sum tests were performed to compare the incidence of liver damages,adjustment or termination of antitubercular treatment,and HBV reactivations between two groups.Results Liver damage was observed in 5 patients （5/35,14.29%） of combination group and in 15 patients （15/33,45.45%） of single group （x2 =7.95,P 〈 0.05）.One patient （1/35,2.86%） in combination group adjusted the therapy,while 13 patients （13/33,39.39%） in single group adjusted or terminated treatment （x2 =13.87,P 〈0.01）.HBV reactivation occurred in 2 patients （2/35,5.71%） of combination group,but in 10 patients （10/33,30.30%） of single group （x2 =7.34,P 〈 0.01）.Conclusion Telbivudine can effectively alleviate liver dysfunction during antitubercular treatment in pulmonary tuberculosis patients with HBV DNA positive chronic HBV infections.

关 键 词：肝炎病毒 乙型 结核 肺 抗结核药 药物性肝损伤 替比夫定 

分 类 号：R521[医药卫生—内科学] R512.62[医药卫生—临床医学]