两种不同化疗方案治疗肺结核合并慢性乙型肝炎患者疗效及对肝功能的影响

doi:10.3969/j.issn.1672-5069.2014.05.012

摘要/Abstract

摘要： 目的探讨两种不同化疗方案治疗肺结核合并慢性乙型肝炎患者的疗效及对肝功能的影响。方法选取本院2010年10月~2012年12月诊治的肺结核合并慢性乙型肝炎患者116例,随机法分为对照组58例,采用2HRZE/4HR及半年化疗疗程,观察组58例患者采用3HESG/9HEG及一年化疗疗程,比较两组患者的治疗效果、肝功能指标改变情况和不良反应发生情况。结果观察组患者总有效率、痰菌转阴率、病灶吸收好转率、空洞缩小率、空洞闭合率分别为98.3%、87.9%、94.8%、93.1%和79.3%,均显著高于对照组患者（87.9%、65.5%、75.9%、72.4%和54.3%）;观察组患者AST、ALT、TBIL、ALB、INR、肝功能恢复正常时间分别为（51.7±6.8） U/L、（52.3±7.2 ）U/L、（26.4±5.7） μmol/L、（37.8±7.6） g/L、（1.1±0.4）、（16.7±5.8） d,均显著低于对照组患者[（69.3±12.1） U/L、（70.5±11.3） U/L、（36.5±4.3） μmol/L、（48.5±9.2） g/L、（1.5±0.6）和（28.9±10.3）d];观察组患者肝功能异常发生率、不良反应发生率分别为29.3%和3.4%,显著低于对照组患者（62.1%和15.5%）;观察组患者肝功能异常出现时间为（35.7±9.6） d,显著晚于对照组[（17.4±8.2）d,P<0.05]。结论3HESG/9HEG及一年化疗疗程治疗肺结核合并慢性乙型肝炎患者的效果显著,肝损害发生率低、发生时间晚且损伤轻,值得进一步验证。

关键词: 肺结核, 慢性乙型肝炎, 化疗, 疗效, 药物性肝损伤

Abstract: Objective To investigate the effectiveness and impact on liver function of two different chemotherapy regimens in treatment of patients with pulmonary tuberculosis complicated by chronic hepatitis B. Methods One hundred and sixteen patients with pulmonary tuberculosis and chronic hepatitis B were recruited in our hospital from October 2010 to December 2012. The patients were then randomly divided into two groups. Patients in control group （n=58） were treated with 2HRZE/4HR for half a year,and patients in observation group（n=58） were treated with 3HESG/9HEG for one year. The effectiveness,impact on liver function and adverse reactions were recorded and compared between the two groups. Results Total efficiency,rate of bacteriologic conversion of sputum,rate of focus absorption,rate of cavity shrinking and rate of cavity closure in patients in observation group were 98.3%,87.9%,94.8%,93.1%and 79.3%,respectively,significantly higher than in the controls（87.9%,65.5%,75.9%,72.4%and 54.3%,respectively）;AST,ALT,TBIL,ALB and INR and restoration time of abnormal liver function in observation group were （51.7±6.8） U/L,（52.3±7.2） U/L,（26.4±5.7） μ mol/L,（37.8±7.6） g/L,（1.1±0.4）and （16.7±5.8） d,significantly lower or less than in the controls[（69.3±12.1） U/L,（70.5±11.3） U/L,（36.5±4.3） μmol/L,（48.5±9.2） g/L,（1.5±0.6）and（28.9±10.3） d,respectively];incidence of abnormal liver function and adverse reaction rates in patients in observation group were 29.3% and 3.4%,significantly lower than in the controls（62.1% and 15.5%,respectively）;time for appearance of abnormal liver function in observation group was（35.7±9.6） d,significantly longer than in the controls[（17.4±8.2）d,P<0.05]. Conclusions Chemotherapy with 3HESG/9HEG for one year is safe and effective in treatment of patients with pulmonary tuberculosis complicated by chronic hepatitis B,with low incidence and later occurrence of liver injury.

Key words: Pulmonary tuberculosis, Chronic hepatitis B, Chemotherapy, Effectiveness, Drug induced liver injury

吕玉凤. 两种不同化疗方案治疗肺结核合并慢性乙型肝炎患者疗效及对肝功能的影响[J]. 实用肝脏病杂志, 2014, 17(5): 493-497.

Lyu Yufeng. Effectiveness and impact on liver functions of two different chemotherapy regimens in treatment of patients with pulmonary tuberculosis complicated by chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(5): 493-497.

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