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[目的]观察肺结核合并慢性乙型病毒性肝炎(乙肝)患者,在结核治疗中联合应用拉米夫定对肝功能的影响。[方法]68例服用抗结核药物的慢性乙肝患者,随机分为2组。拉米夫定组33例,强化期服用异烟肼、利福平、吡嗪酰胺、乙胺丁醇2个月,巩固期服用异烟肼、利福平、乙胺丁醇7个月,同时给予拉米夫定100mg,每天1次口服;对照组35例,服用与拉米夫定组相同的抗结核治疗方案。评价治疗前后患者临床症状、肝功能及HBV DNA。[结果]拉米夫定组肝损伤发生率为9.09%;对照组为40.0%(P<0.01);拉米夫定组临床症状和肝功能明显好于对照组(P<0.01);治疗结束时,拉米夫定组患者HBV DNA为(3.1±0.3)lg拷贝/ml,对照组为(6.5±0.8)lg拷贝/ml。随访期间,2组间肝炎发病率比较差异无统计学意义(P>0.05)。[结论]拉米夫定可以减少肺结核合并慢性乙肝患者抗结核治疗导致的药物性肝损伤的发生机率和程度,安全性好。
[Objective] To observe the effect of combined application of lamivudine on liver function in patients with tuberculosis and chronic hepatitis B (hepatitis B). [Method] Sixty-eight chronic hepatitis B patients taking anti-tuberculosis drugs were randomly divided into two groups. In the lamivudine group, 33 cases were treated with isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months during intensive phase, 7 months for isoniazid, rifampin and ethambutol during the consolidation period, At the same time given lamivudine 100mg, 1 day orally; control group of 35 patients, taking the same anti-TB treatment with lamivudine treatment. Evaluation of patients before and after treatment of clinical symptoms, liver function and HBV DNA. [Results] The incidence of liver injury was 9.09% in lamivudine group and 40.0% in control group (P <0.01). The clinical symptoms and liver function in lamivudine group were significantly better than those in control group (P <0.01) , HBV DNA was (3.1 ± 0.3) lg copies / ml in the lamivudine group and (6.5 ± 0.8) lg copies / ml in the control group. During follow-up, there was no significant difference in the incidence of hepatitis between the two groups (P> 0.05). [Conclusion] Lamivudine can reduce the incidence and extent of drug-induced liver injury caused by antituberculosis treatment in patients with pulmonary tuberculosis and chronic hepatitis B, with good safety.