恩替卡韦治疗合并肺结核的慢性乙型肝炎效果观察  

Clinical effect of entecavir in treatment of patients with chronic hepatitis B complicated by tuberculosis

作　　者：朱栋梁[1] 李道波[1,2] 赵满芝[1] 马科[1] 宋建新[1] 许东[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院感染科,武汉430030 [2]湖北省公安县中医院肝病科,湖北荆州434300

出　　处：《临床肝胆病杂志》2016年第11期2084-2087,共4页Journal of Clinical Hepatology

基　　金：湖北省自然科学基金资助项目(2013CFB077)

摘　　要：目的探索恩替卡韦抗病毒治疗在慢性乙型肝炎（CHB）合并肺结核患者抗结核治疗过程中的有效性。方法回顾性分析2007年6月-2013年12月华中科技大学同济医学院附属同济医院收治的95例CHB合并肺结核患者,按是否在抗结核治疗的同时行恩替卡韦抗病毒治疗分为治疗组（n=38）和对照组（n=57）,对其治疗前后临床生化指标等的变化情况及转归等进行比较。计量资料组间比较采用t检验或Mann-Whitey U检验,计数资料组间比较采用χ2检验。结果治疗过程中,对照组患者ALT、AST显著高于治疗组[（382.7（260.7-635.9）U/L vs 143.3（97.9-260.4）U/L,Z=-4.225,P〈0.001;280.7（197.6-461.8）U/L vs93.8（67.3-156.9）U/L,Z=-4.637,P〈0.001],TBil显著升高[157.4（139.7-269.6）μmol/L vs（106.8（88.3-187.1）μmol/L,Z=-2.671,P=0.008],出现黄疸的比例明显增高（63.2%vs 34.2%,χ2=7.650,P=0.007）。对照组患者在治疗过程中,PT明显延长[（22.5±15.5）s vs（17.3±9.7）s,t=2.553,P=0.012],PLT水平偏低[（131.0±69.4）×10^9/L vs（181.7±105.6）×10^9/L,t=2.826,P=0.004]。对照组发生肝衰竭的比例显著增高（42.1%vs 15.8%,χ2=7.306,P〈0.001）,且治疗过程中,对照组患者因为肝功能受损而被迫停用部分或全部抗结核药物的概率亦增高（17.5%vs 2.6%,χ2=4.952,P=0.026;68.4%vs 15.8%,χ2=25.330,P〈0.001）。结论 CHB合并肺结核患者在抗结核过程中,予以恩替卡韦抗病毒治疗可有效降低抗结核过程中肝损伤的发生,从而保障抗结核治疗的有效性和安全性,值得临床进一步探究。Objective To investigate the clinical effect of entecavir in the treatment of patients with chronic hepatitis B（ CHB） complicated by tuberculosis during anti- tuberculosis treatment. Methods A retrospective study was performed for the clinical data of 95 patients with CHB complicated by tuberculosis,and according to the application of entecavir antiviral therapy during anti- tuberculosis treatment,these patients were divided into treatment group and control group. The changes in clinical biochemical parameters and prognosis after treatment were compared between the two groups. The t- test or Mann- Whitney U test were used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results During the treatment,compared with the treatment group,the control group had significantly higher alanine aminotransferase [382. 7（ 260. 7- 635. 9） U / L vs 143. 3（ 97. 9-260. 4） U / L,Z =- 4. 225,P〈0. 001] and aspartate aminotransferase [280. 7（ 197. 6- 461. 8） U / L vs 93. 8（ 67. 3- 156. 9） U / L,Z =- 4. 637,P〈0. 001]and significant increases in total bilirubin [157. 4（ 139. 7- 269. 6） μmol / L vs 106. 8（ 88. 3- 187. 1） μmol / L,Z =- 2. 671,P = 0. 008] and the proportion of patients with jaundice（ 63. 2% vs 34. 2%,χ2= 7. 650,P = 0. 007）. Compared with the treatment group,the control group had a significantly prolonged prothrombin time（ 22. 5 ± 15. 5 s vs 17. 3 ± 9. 7 s,t = 2. 553,P = 0. 012）and a significantly lower platelet count [（ 131. 0 ± 69. 4） ×10^9 L vs（ 181. 7 ± 105. 6） ×10^9 L,t = 2. 826,P = 0. 004] during treatment.Compared with the treatment group,the control group had significant increases in the proportions of patients with liver failure（ 42. 1% vs15. 8%,χ2= 7. 306,P〈0. 001） and patients who were forced to stop all or part of antitubercular agents due to liver impairment during treatment（ withdrawal of all antitubercular agents： 17. 5% vs 2. 6%,χ2= 4. 952,P = 0. 026; withdr

关 键 词：肝炎 乙型 慢性 结核 恩替卡韦 治疗 

分 类 号：R512.62[医药卫生—内科学]