恩替卡韦治疗乙型肝炎病毒携带者合并肺结核患者临床疗效分析

doi:10.3969/j.issn.1672-5069.2020.03.010

摘要/Abstract

摘要： 目的探讨在抗结核治疗过程中应用恩替卡韦预防性治疗肺结核合并HBV携带者对肝损伤的保护作用。方法 2017年5月～2018年12月我院诊治的HBV携带者合并肺结核患者164例,随机将患者分为观察组82例和对照组82例。两组均接受4HREZ/4ER方案抗结核治疗,观察组在抗结核治疗的基础上应用恩替卡韦预防性抗病毒治疗。结果在治疗8周末,观察组血清ALT和AST水平分别为(44.2±1.1)U/L和(38.8±1.3)U/L,显著低于对照组【(81.7±1.5) U/L和(78.2±1.5) U/L,P＜0.05】,血清HBV DNA全部阴转,而对照组仍保持在治疗前水平【(7.9±0.6)lg copies/mL,P＜0.05】;在治疗8周末,观察组肺结核病灶显著吸收、吸收和痰菌阴转率分别为41.5%、42.7%和48.8%,显著高于对照组的24. 4%、28.1%和34.2% (P＜0.05);观察组外周血CD4⁺细胞、CD8⁺细胞百分比和CD4⁺/CD8⁺比值分别为(39.5±3.1)%、(23.9±1.8)%和(1.7±0.2),与对照组的【(37.1±2.5)%、(26.3±1.3)%和(1.4±0.3),P<0.05】比,差异显著;观察组乏力、肝区不适、食欲减退和肝功能损害发生率分别为3.7%、2.4%、1.2%和1.2%,显著低于对照组(分别为15.9%、12.2%、4.9%和53.7%,P<0.05);在治疗3月末,观察组发生抗结核药物耐药、因肝损害被迫停用某些药物和终止抗结核治疗发生率分别为7.3%、4.7%和1.2%,显著低于对照组的18.3%、12.2%和36.6%(P<0.05)。结论肺结核合并HBV携带者在抗结核治疗的同时应用恩替卡韦治疗能显著降低肝损害发生率,保证抗结核治疗的顺利和按计划进行,可能与抑制了病毒被激活,保持了正常的免疫监视功能,减少了不良反应的发生。由于抗结核持续进行,就不会或尽可能少地发生耐药菌株的出现,具有重要的临床意义。

关键词: 乙型肝炎病毒携带者, 肺结核, 恩替卡韦, 抗结核治疗, 淋巴细胞亚群 , ,

Abstract: Objective The aim of this study was to observe the application of entecavir in the treatment of patients with hepatitis B virus carrier and pulmonary tuberculosis during antituberculotic therapy. Methods 164 patients with hepatitis B virus carrier and pulmonary tuberculosis were recruited in our hospital between May 2017 and December 2018, and were randomly divided into observation and control group with 82 cases in each. All the patients were given 4 HREZ/4 ER, and those in the observation group were given entecavir orally for anti-viral therapy. The liver function index, peripheral blood lymphocyte subsets and serum HBV DNA were detected. Results At the end of eight week treatment, serum ALT and AST levels in the observation group were (44.2±1.1)U/L and (38.8±1.3)U/L, significantly lower than 【(81.7±1.5) U/L and (78.2±1.5) U/L, respectively, P＜0.05】 in the control, all serum HBV DNA became negative in the observation group, while they were 【(7.9±0.6)lg copies/mL, P＜0.05】, unchanged in the control; at the end of eight week treatment, the total absorption rate and absorption of tubercular lesions, and sputum smear negative conversion rate in the observation group were 41.5%, 42.7% and 48.8%, significantly higher than 24. 4%, 28.1% and 34.2% , respectively, in the control(P＜0.05); the percentages of peripheral blood CD4⁺ cells,CD8⁺ cells and ratio of CD4⁺/CD8⁺ cells in the observation group were (39.5±3.1)%, (23.9±1.8)% and (1.7±0.2), significantly different as compared to 【(37.1±2.5)%, (26.3±1.3)% and (1.4±0.3), respectively, P<0.05】 in the control group; the incidences of fatigue, right upper-chondrial discomfort, anorexia and drug-induced liver injuries (DILI) in the observation goup were 3.7%, 2.4%, 1.2% and 1.2%, significantly lower than 15.9%, 12.2%, 4.9% and 53.7%, respectively in the control (P<0.05); at the end of three month treatment, the anti-tuberculosis drug resistance rate, discontinuation of some anti-tuberculosis agents because of DILI and totally discontinuation of anti-tuberculosis therapy in the observation were 7.3%. 4.7% and 1.2%, significantly lower than 18.3%, 12.2% and 36.6%, respectively, in the control group(P<0.05). Conclusions The prophylactic application of entecavir in hepatitis B viral carriers complicated with pulmonary tuberculosis during anti-tuberculosis treatment has a good efficacy in inhibiting hepatitis B viral re-activation, which might guarantee the anti-tuberculosis therapy going and immune functions with little side effects and less drug-induced liver injuries.

Key words: Hepatitis B viral carrier, Pulmonary tuberculosis, Entecavir, Anti-tuberculosis therapy, Lymphocyte subsets

方利娟,吴雄飞. 恩替卡韦治疗乙型肝炎病毒携带者合并肺结核患者临床疗效分析[J]. 实用肝脏病杂志, 2020, 23(3): 340-343.

Fang Lijuan, Wu Xiongfei. Application ofentecavir in the treatment of patients with hepatitis B virus carrier and pulmonary tuberculosis during antituberculotic therapy[J]. Journal of Practical Hepatology, 2020, 23(3): 340-343.

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