恩替卡韦治疗血清HBeAg阳性高病毒载量乙型肝炎病毒携带者合并肺结核患者预防抗痨治疗引起的药物性肝损伤效果研究*

doi:10.3969/j.issn.1672-5069.2023.04.016

实用肝脏病杂志 ›› 2023, Vol. 26 ›› Issue (4): 516-519.doi: 10.3969/j.issn.1672-5069.2023.04.016

恩替卡韦治疗血清HBeAg阳性高病毒载量乙型肝炎病毒携带者合并肺结核患者预防抗痨治疗引起的药物性肝损伤效果研究^*

唐新华, 唐慧京, 黄成军, 李观

541001 广西壮族自治区桂林市桂林医学院附属第三人民医院肺病科(唐新华,李观);肝病科(黄成军);附属第二医院重症医学科(唐慧京)

收稿日期:2022-10-24 出版日期:2023-07-10 发布日期:2023-07-21
通讯作者: 李观,E-mail:liguan0425@163.com
作者简介:唐新华,男,46岁,大学本科,副主任医师。E-mail:t3578962022@163.com
基金资助:
^*广西壮族自治区卫健委自筹经费科研项目(编号:Z2019082)

Preventive effect of entecavir on anti-tuberculosis drug-induced liver injury in patients with pulmonary tuberculosis and serum HBeAg-positive high HBV loads

Tang Xinhua, Tang Huijing, Huang Chengjun, et al

Department of Pulmonary Diseases, Third People's Hospital, Affiliated to Guilin Medical College, Guilin 541001,Guangxi Zhuang Autonomous Region, China

Received:2022-10-24 Online:2023-07-10 Published:2023-07-21

摘要/Abstract

摘要： 目的探讨在抗痨治疗过程中应用恩替卡韦预防治疗血清HBeAg阳性高病毒载量的乙型肝炎病毒(HBV)携带者合并肺结核(PTB)患者对预防药物性肝损伤(DILI)的效果。方法 2019年1月～2022年1月我院收治的96例血清HBeAg阳性高病毒载量的HBV携带者合并PTB患者,被随机分为观察组48例和对照组48例。两组均接受标准的抗痨治疗,观察组在抗痨治疗的基础上应用恩替卡韦进行预防性抗HBV治疗,均持续治疗6个月。采用PCR-荧光免疫探针法检测血清HBV DNA载量。结果在治疗1个月、3个月和6个月,观察组DILI累计发生率分别为12.5%、16.7%和18.8%,显著低于对照组的29.1%、45.8%和54.2%(P＜0.05);在治疗3个月,8例观察组发生DILI患者血清ALT、AST和HBV DNA水平分别为(67.7±8.5)U/L、(57.1±4.7)U/L和(1.1±0.2)lg IU/mL,均显著低于22例对照组【分别为(104.5±13.9)U/L、(96.9±15.3)U/L和(6.6±1.4)lg IU/mL,P＜0.05】;在治疗过程中,观察组肝区不适、胃肠道症状、血清肌酸激酶升高、药疹和中止抗痨等不良反应发生率为10.4%,显著低于对照组的27.1%(P＜0.05);在治疗结束时,观察组均获得治愈(100.0%),而在对照组治愈41例(85.4%,P<0.05),其中7例患者在延长疗程后才获得PTB的治愈。结论应用恩替卡韦可有效降低血清HBeAg阳性高病毒载量的HBV携带者合并PTB患者在抗痨治疗过程中DILI发生率,保证抗痨治疗的顺利进行,而使患者获益。

关键词: 药物性肝损伤, 乙型肝炎病毒携带者, 肺结核, 恩替卡韦, 抗痨治疗

Abstract: Objective The aim of this study was to investigate the preventive effect of entecavir on anti-tuberculosis drug-induced liver injury (DILI) in patients with pulmonary tuberculosis (PTB) and serum HBeAg-positive high HBV loads. Methods A total of 96 HBV carriers with PTB who had high HBV loads with serum HBeAg-positive were encountered in our hospital between January 2019 and January 2022, and were randomly divided into control and observation group, with 48 cases in each group. All the patients were given standardized anti-tuberculosis regimen for six months, and those in the observation group were given entecavir simultaneously. Serum HBV DNA loads was detected by PCR. Results At the end of one, three and six month treatment, the cumulative incidences of DILI in the observation group were 12.5%, 16.7% and 18.8%, all significantly lower than 29.1%, 45.8% and 54.2%(P＜0.05) in the control; at the end of three month treatment, serum ALT, AST and HBV DNA in 8 patients with DILI in the observation group were(67.7±8.5)U/L,(57.1±4.7)U/L and (1.1±0.2)lg IU/mL, all significantly lower than [(104.5±13.9)U/L, (96.9±15.3)U/L and (6.6±1.4)lg IU/mL, respectively, P＜0.05] in 22 patients with DILI in the control; during the anti-tuberculosis treatment, the incidence of complications, such as right epigastric discomfort, nausea and vomiting, elevated serum creatine kinase level, rash and non-planned discontinuation of anti-tuberculosis treatment in the observation group was 10.4%, much lower than 27.1%(P＜0.05) in the control; all patients (100.0%)in the observation group recovered, while the recovery rate in the control was 85.4%(P<0.05), left seven patients recovered after prolongation of anti-tuberculosis therapy. Conclusion The application of entecavir could effectively reduce the incidence of anti-tuberculosis DILI in HBV carriers with PTB, especially in those with serum HBeAg-positive and high HBV DNA loads, which warrants further investigation.

Key words: Drug-induced liver injury, Hepatitis B viral carriers, Pulmonary tuberculosis, Entecavir, Anti-tuberculosis therapy

唐新华, 唐慧京, 黄成军, 李观. 恩替卡韦治疗血清HBeAg阳性高病毒载量乙型肝炎病毒携带者合并肺结核患者预防抗痨治疗引起的药物性肝损伤效果研究^*[J]. 实用肝脏病杂志, 2023, 26(4): 516-519.

Tang Xinhua, Tang Huijing, Huang Chengjun, et al. Preventive effect of entecavir on anti-tuberculosis drug-induced liver injury in patients with pulmonary tuberculosis and serum HBeAg-positive high HBV loads[J]. Journal of Practical Hepatology, 2023, 26(4): 516-519.

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恩替卡韦治疗血清HBeAg阳性高病毒载量乙型肝炎病毒携带者合并肺结核患者预防抗痨治疗引起的药物性肝损伤效果研究^*

Preventive effect of entecavir on anti-tuberculosis drug-induced liver injury in patients with pulmonary tuberculosis and serum HBeAg-positive high HBV loads

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