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

Abstract

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

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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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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