慢性乙肝病毒携带的初治肺结核患者抗结核治疗方案的临床研究  

Anti-TB chemotherapy regimens for newly diagnosed pulmonary tuberculosis patients carrying hepatitis B virus

作　　者：方勇[1] 胡海琍[1] 

机构地区：[1]同济大学附属肺科医院结核病诊疗中心,上海200433

出　　处：《同济大学学报（医学版）》2014年第3期91-94,共4页Journal of Tongji University(Medical Science)

摘　　要：目的研究慢性乙肝病毒携带的肺结核患者抗结核治疗方案的选择。方法选择我院2009年1月1日至2012年12月31日慢性乙肝病毒携带的活动性初治肺结核患者153例,无乙肝病毒感染的活动性初治肺结核患者作为对照组共158例,两组患者均排除具有肝功能损害高危险因素者,均无其他合并症。初始均以标准初治方案异烟肼、利福平、乙胺丁醇、吡嗪酰胺四药联合抗结核,治疗过程中若出现肝损,停药护肝,肝功能回复正常后,后续治疗患者按照治疗方案分为2组,A:链霉素、异烟肼、利福喷丁、乙胺丁醇;B:异烟肼、利福喷丁、乙胺丁醇、左氧氟沙星;并对照分析。结果慢性乙肝病毒携带组患者药物性肝损(77例)的发生率(50.3%)显著高于对照组36例(22.8%),(χ2=25.489,P=0.000)。后续治疗中,A、B两组方案肝损发生率分别为12.8%和15.8%,较标化方案显著下降,且两组之间肝损发生率及疗效比较差异均无统计学意义。结论慢性乙肝病毒携带的肺结核患者,异烟肼、利福平、乙胺丁醇、吡嗪酰胺四药联合标准初治抗结核治疗方案肝功能损害发生率较大,建议以异烟肼、利福喷汀、乙胺丁醇、链霉素及左氧氟沙星等药物组成的治疗方案替代。Objective To evaluate the anti-TB therapeutic regimens in newly diagnosed pulmonary tuberculosis patients carrying hepatitis B virus（HBV）.Methods One hundred and fifty three HBV carriers with untreated active pulmonary tuberculosis and 158 non-HBV carriers TB patients admitted in hospital from January 2009 to December 2012 were enrolled in the study.The therapeutic regimen HRZE（Isoniazid,Rifampin,Pyrazinamide,Ethambutol） was initially started.The therapy would be terminated if antituberculous drug-induced liver injury developed.After liver function returned to normal the patients were assigned to receive follow-up regimen A（Streptomycin,Isoniazid,Rifapentine,Ethambutol） or B（Isoniazid,Rifapentine Ethambutol,Levofloxacin）.Results The incidence of antituberculous drug-induced liver injury in HBV carriers was significantly higher than that in nonHBV carriers（χ2= 25.489,P = 0.000）.The occurrence of drug-induced liver injury was significantly lower in two follow-up regimens（12.8% and 15.8%） than that in initial regimen.There was no significant difference in therapeutic efficacy of follow up regimens between groups A and B.Conclusion The risk of anti-TB therapeutic regimen HREZ for chronic hepatitis B virus carriers is relative higher and two follow-up regimens are safe and effective.

关 键 词：结核 肺 药物疗法 肺 并发症 乙型肝炎病毒 

分 类 号：R563[医药卫生—呼吸系统]