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目的探讨拉米夫定抗病毒治疗对乙肝合并肺结核患者细胞免疫功能及肝功能的影响。方法选择2010年5月—2014年10月长阳土家族人民医院就诊的190例乙肝合并肺结核患者为研究对象,根据入院时间分为观察组和对照组各95例,观察组根据肝功能水平分为肝功能异常组23例和肝功能正常组72例。对照组予2HRZE/4HR+护肝片+维生素C治疗,观察组在对照组基础上联合使用拉米夫定,比较各组乙肝DNA水平、T淋巴细胞亚群、肝功能。结果治疗后,观察组HBV-DNA水平(4.12±0.24)×10~6copies/mL低于对照组(6.87±0.56)×10~6copies/mL(P<0.05);T淋巴细胞亚群CD4~+、CD4/CD8高于对照组,CD8+低于对照组(P<0.05)。肝功能正常组血清丙氨酸氨基转氨酶、天冬氨酸氨基转氨酶、总胆红素水平均低于肝功能异常组、对照组(P<0.05)。结论拉米夫定抗病毒治疗有助于改善乙肝合并肺结核患者免疫功能,抑制乙肝病毒复制,保护肝功能。
Objective To investigate the effect of lamivudine antiviral therapy on cellular immunity and liver function in patients with hepatitis B and pulmonary tuberculosis. Methods From May 2010 to October 2014, 190 cases of hepatitis B patients with pulmonary tuberculosis treated by Changyang Tujia People’s Hospital were enrolled. According to the time of admission, the patients were divided into observation group and control group, 95 cases each. The observation group was divided according to liver function level 23 cases of abnormal liver function group and 72 cases of normal liver function group. The control group was given 2HRZE / 4HR + Hugan tablet + vitamin C treatment. The observation group was treated with lamivudine on the basis of the control group, and the HBV DNA level, T lymphocyte subsets and liver function were compared between the two groups. Results After treatment, the levels of HBV-DNA in the observation group (4.12 ± 0.24) × 10 ~ 6copies / mL were lower than those in the control group (6.87 ± 0.56) × 10 ~ 6copies / mL , CD4 / CD8 higher than the control group, CD8 + lower than the control group (P <0.05). Serum levels of alanine aminotransferase, aspartate aminotransferase, and total bilirubin in patients with normal liver function were lower than those in patients with abnormal liver function and control group (P <0.05). Conclusion Antiviral therapy with lamivudine can improve the immune function, inhibit the replication of hepatitis B virus and protect the liver function in patients with hepatitis B and pulmonary tuberculosis.