论文部分内容阅读
目的探讨在肺结核合并HBV感染的抗痨治疗中,依据HBV-DNA检测结果,选择性抗病毒治疗的优越性和不足。方法肺结核合并HBV感染患者117例,其中HBV-DNA阳性组51例(抗痨起始时联用拉米夫定,为A组)、HBV-DNA阴性组66例(抗痨后监测HBV-DNA,若HBV-DNA阳转,则加用拉米夫定,为B组);对照组为121例HBsAg阴性的肺结核患者,为C组;上述三组均给予“2HRZE/4HR”方案抗痨,同时密切监测肝功能和HBV-DNA。结果 A、B、C三组的肝损害率分别为:21.6%、15.2%和5.8%;三组抗痨中断率分别为:5.9%、3.0%和0.8%;三组病例均无肝损害相关性死亡发生。A、B组的肝损害率及A组的抗痨中断率与C组对比差异均有统计学意义。B组在抗痨全过程中始终保持HBV-DNA阴性者有54例,与C组对比在肝损害率及抗痨中断率方面差异均无统计学意义。结论依据HBV-DNA检测结果,选择性抗病毒治疗,能有效降低抗痨时的肝损害,并能避免大部分HBV-DNA阴性时不必要的抗病毒治疗。但HBV感染时行抗痨,抗病毒治疗并不能最大程度地避免肝损害的发生。
Objective To investigate the advantages and disadvantages of selective antiviral therapy in the anti-tuberculosis treatment combined with HBV infection based on the results of HBV-DNA test. Methods A total of 117 patients with pulmonary tuberculosis and HBV infection were enrolled. Among them, 51 were HBV-DNA positive (group A) , If the positive of HBV-DNA was positive, add lamivudine for group B); the control group was 121 cases of HBsAg-negative pulmonary tuberculosis, which was group C; all the three groups were given “2HRZE / 4HR”痨, while closely monitoring liver function and HBV-DNA. Results The liver damage rates in groups A, B and C were 21.6%, 15.2% and 5.8%, respectively; the interruption rates of anti-tuberculosis in the three groups were 5.9%, 3.0% and 0.8% respectively; Sexual death occurs. A, B group of liver damage rate and A group of anti-tuberculosis interrupt rate compared with the C group were statistically significant differences. In group B, there were 54 cases of HBV-DNA negative in the whole process of anti-tuberculosis. There was no significant difference in the rate of liver damage and anti-tubal disruption among group C compared with group C. Conclusions Based on the results of HBV-DNA test, selective antiviral therapy can effectively reduce liver damage during anti-tuberculosis and avoid unnecessary antiviral treatment when most HBV-DNA negative. However, when infected with HBV anti-tuberculosis, antiviral therapy and can not maximize the occurrence of liver damage.