摘要
目的验证核苷(酸)类似物抗病毒治疗对肺结核合并乙肝病毒携带者抗结核药物所致肝损害的预防作用。方法采用匹配法对159例肺结核合并乙肝病毒携带者分成抗结核药加阿德福韦酯组(A组)、抗结核药加恩替卡韦组(B组)和单纯用抗结核药组(C组),每组53例。治疗前每例患者均查乙型肝炎病毒标志物、肝功能和血清HBV DNA水平,治疗后每4周查肝功能,第12周及第24周复查血清HBV DNA水平。对各组出现的肝损害例数及血清HBV DNA水平进行比较。结果 A、B、C组累积肝损害分别为19例(35.85%)、17例(32.08%)和22例(41.51%)肝损害发生的累积例数各组间均差异无统计学意义(P>0.05)。抗病毒治疗后24周后,A组HBV DNA水平log10中位数为4.56IU/ml,B组为3.36 IU/ml,C组为6.16 IU/ml。两两比较,差异均有统计学意义(P<0.05)。抗病毒治疗前与抗病毒治疗24周后,A、B组差异有统计学意义(P<0.05、<0.01),C组差异无统计学意义(P>0.05)。治疗24周后A组有4例累积(7.55%)、B组有6例(11.32%)患者血清HBV DNA水平下降到低于检测下限,C组无患者血清HBV DNA水平下降到低于检测下限,A组与B组差异无统计学意义(P>0.05),A组与C组、B组与C组差异均有统计学意义(P均<0.05)。结论阿德福韦酯或恩替卡韦同时与抗结核药应用可降低HBVDNA水平,但对预防肺结核合并乙肝病毒携带者抗结核药物所致肝损害的作用有限。
Objective To test and verify if nucleotide analogues can prevent anti-tuberculosis agents induced liver injury in tuberculosis patients with HBV co-infection.Methods A total of 159 pulmonary tuberculosis patients with HBV co-infection were divided into 3 groups.Group A received anti-tuberculosis agents and Adefovir dipivoxil,group B received anti-tuberculosis agents and Entecavir, group C only received anti-tuberculosis agents, and each group contained 53 pa- tients.Before treatment d HBV markers, liver function and serum HBVDNA levels of each patient were tested. Liver function each 4 weeks after treatment, and HBVDNA in 12th and 24th week were tested.Results Group A ,B,C accumu- lated respectively 19（35.85 %）, 17 （32.08 % ）, 22 （41.51 G） cases with liver injury, which was not significantly different （P〉0.05）. The log10 medium HBVDNA of group A was reduced to 4.56 IU/ml, of group B to 3.36 IU/ml,of group C to 6.16 IU/ml 24 weeks treatment, which were significantly different （P〈0.05）.The log10 medium HBVDNA in group A and group B were significantly different between before treatment and 24 weeks after treatment （P〈 0.05）. At 24 weeks after treatment, the HBVDNA levels of 4 cases in group A, 6 cases in group B achieved undetectable levels, which was not significantly different between group A and group B （P〉0.05）, but different between group A to C, and group B and C （P〈0.05）.Conelusion Adefovir dipivoxil or Enteeavir can reduce the serum HBVDNA levels, but can not pre- vent anti-tuberculosis agents induced liver injury in tuberculosis patients with HBV co-infection.
出处
《华南国防医学杂志》
CAS
2015年第11期836-838,共3页
Military Medical Journal of South China
基金
湖南省卫生计生委2015年度科研计划课题项目(B2015-63)
关键词
肺结核
乙型肝炎病毒携带者
预防
抗结核药
肝损害
阿德福韦酯
恩替卡韦
Pulmonary tuberculosis
Hepatitis B virus carrier
Prevention
Anti-tuberculosis agents
Liver injury
Adefovir dipivoxil
Entecavir
