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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 verify the preventive effect of nucleoside (acid) analogue antiviral therapy on liver damage caused by anti-TB drugs in patients with pulmonary tuberculosis and hepatitis B virus infection. Methods A total of 159 pulmonary tuberculosis patients with hepatitis B virus infection were divided into group A with antituberculosis drugs plus adefovir dipivoxil, group B with antituberculotics plus entecavir, group C with anti-tuberculosis drugs alone, 53 cases in each group. Hepatitis B virus markers, liver function and serum HBV DNA levels were examined in each patient before treatment. The liver function was checked every 4 weeks after treatment, and serum HBV DNA levels were examined at the 12th and 24th week. The incidence of liver damage in each group and serum HBV DNA levels were compared. Results The cumulative liver damage in groups A, B and C were 19 cases (35.85%), 17 cases (32.08%) and 22 cases (41.51%), respectively. There was no significant difference between groups > 0.05). After 24 weeks of antiviral therapy, the median log10 of HBV DNA in group A was 4.56 IU / ml, in group B was 3.36 IU / ml and in group C 6.16 IU / ml. Pairwise comparison, the difference was statistically significant (P <0.05). The difference between A and B groups was statistically significant (P <0.05, <0.01) after 24 weeks of antiviral treatment and antiviral treatment, but there was no significant difference between C and A groups (P> 0.05). After 24 weeks of treatment, the serum HBV DNA level dropped to below the detection limit in group A (4 cases) and 6 cases (11.32%) in group B, and decreased to below the detection limit There was no significant difference between group A and group B (P> 0.05). There was significant difference between group A and group C, group B and group C (all P <0.05). Conclusion Adefovir dipivoxil or entecavir at the same time with the application of anti-TB drugs can reduce the level of HBVDNA, but to prevent tuberculosis and hepatitis B virus carriers of anti-TB drug-induced liver damage is limited.