替比夫定和甘草酸二铵联合治疗肺结核合并慢性乙肝病毒携带者  

Telbivudine combined with Diammonium glycyrrhiziate in treatment of pulmonary tuberculosis and chronic HBV carriers

作　　者：林小田[1] 王昱[1] 谢媛琪[1] 蔡立莉[1] 谢国强 赵兴辉[1] LIN Xiaotian;WANG Yu;XIE Yuanqi;CAI Lili;XIE Guoqiang;ZHAO Xinghui(Department of Infectious Diseases,The No.422 Hospital of the PLA,Zhanjiang,Guangdong 524009,China)

机构地区：[1]中国人民解放军第422医院感染内科,广东湛江524009

出　　处：《中国热带医学》2018年第10期1054-1057,1060,共5页China Tropical Medicine

基　　金：湛江市科技攻关计划项目(No.2014B01190)

摘　　要：目的探讨替比夫定和甘草酸二铵联合治疗肺结核合并慢性乙肝病毒(HBV)携带者,以评价其在抗结核化疗过程中对肝脏的保护作用。方法选择2013年1月—2016年12月门诊和住院诊断的156例肺结核合并慢性HBV患者,采用随机对照方法分为A、B、C三组,每组各52例。A组按常规化疗方案加葡醛内酯治疗;B组在A组基础上加甘草酸二铵治疗;C组在B组基础上加替比夫定治疗。所有患者随访6个月。结果肝损害情况:疗程结束时,A、B、C三组发生肝损害例数分别为36例(69.2%)、26例(50.0%)和13例(25.0%),差异有统计学意义(P=0.002);两两比较显示,A组肝损害程度高于B组(P=0.038)和C组(P=0.001)。血清HBV DNA载量变化:治疗前,三组血清HBV DNA载量差异无统计学意义(P>0.05);治疗2个月、4个月和6个月后,三组血清HBV DNA载量差异有统计学意义(P<0.05),并且,C组低于A组和B组,差异有统计学意义(P<0.05);而A组与B组差异无统计学意义(P>0.05)。肝纤维指标变化:治疗前,三组患者血清肝纤维指标血清透明质酸(hyaluronic acid, HA)、Ⅲ型前胶原氨基末端肽(precollagen typeⅢN-terminalpeptide,PⅢNP)、Ⅳ型胶原(collagen typeⅣ,Ⅳ-C)和层黏蛋白(Laminin, LN)差异无统计学意义(P>0.05),而治疗后,三组患者血清肝纤维指标HA、PⅢNP、IV-C、LN差异均有统计学意义(P<0.05),经两两比较,HA、PⅢNP、IV-C、LN水平为A组>B组>C组,差异均有统计学意义(P<0.05)。抗结核化疗方案的改变情况:三组患者在治疗过程中化疗方案更改和终止的发生率之间其差异有统计学意义(P<0.05),并且,A组高于C组,差异有统计学意义(P<0.001)。结论替比夫定和甘草酸二铵联合治疗肺结核合并慢性HBV携带者,对减少肝功能损害,抑制HBV DNA复制,减轻肝纤维化发生和维持抗结核化疗方案的顺利实施均有一定的价值。Objective To evaluate the protective effect of the combination of Telbivudine and Diammoniumglycyrrhiziate in the treatment of the patients with pulmonary tuberculosis and chronic HBV carriers（HBV DNA positive）inthe course of anti-tuberculosis chemotherapy. Methods From January 2013 to December 2016, 156 patients with pulmonarytuberculosis and chronic HBV carriers in outpatient and hospitalization were randomly divided into 3 groups, each group with52 cases. Group A was treated by the routine chemotherapy regimen and Glucuro lactone, Group B was treated withDiammonium glycyrrhizinate on the basis of Group A, and Group C was treated with Telbivudine on the basis of Group B. Allpatients followed up for 6 months. Results At the end of the course, the number of liver lesions in group A,group B and groupC respectively, was 36 cases（69.2%）, 26 cases（50.0%） and 13（25.0%）. The difference was statistically significant in the threegroups（P=0.002）. The liver damage rate of Group A was significantly higher than in Group B and Group C,the differences werestatisticcally significant（P〈0.05）. There were no significant differences between the three groups in the serum HBV DNAlevel before treatment（P〈0.05）.After 2, 4 and 6 months of treatment, comparison of the serum HBV DNA level of three groups,the differences were statistically significant（P〈0.05）, especially, Group C was lower, compared with Group A and Group B（P〈0.05）,and there were no significant differences between Group A and Group B（P〈0.05）. Before treatment, the serum level of theserum hyaluronic acid（HA）, the serum precollagen type Ⅲ N-terminal peptide（ PⅢNP）, the serum collagen type Ⅳ（IV-C）and Laminin（LN） were no significant differences（P〈0.05）. And after treatment, three groups of patients serum liver fiber indexHA, P Ⅲ NP, IV-C, LN difference had statistical significance（P〈0.05）, after comparing the two, HA, P Ⅲ NP, IV-C, LNlevels for group A B C, the differences were statisticall

关 键 词：肺结核 慢性HBV携带者 替比夫定 甘草酸二铵 临床研究 

分 类 号：R521[医药卫生—内科学]