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目的探讨抗结核药物联合拉米夫定对肺结核合并乙型肝炎病毒携带患者的疗效。方法选择2010年2月—2013年12月进行诊治的肺结核合并乙型肝炎病毒携带患者82例,随机分为两组。对照组采用国家推荐的抗结核药物治疗方案治疗,观察组在对照组的基础上联合拉米夫定治疗。在治疗后不同时间随访,对比两组的肝功能、HBV-DNA阴转率、治愈率、失败率、复发率、不良反应发生率和病死率。结果治疗后,观察组肝损伤总发生率、AST、ALT、TBIL和TBA分别为19.51%、(98.42±21.53)μ/L、(121.46±26.38)μ/L、(31.62±3.25)μmol/L、(17.42±4.15)μmol/L,均明显低于对照组的46.34%、(326.79±143.92)μ/L、(453.27±146.28)μ/L、(61.42±13.79)μmol/L、(35.12±8.43)μmol/L,差异均有统计学意义(P<0.05);随访1年,观察组的HBV-DNA阴转率和结核病治愈率分别为21.95%、90.24%,明显高于对照组4.88%、68.29%(P<0.05),失败率、复发率、不良反应发生率和死亡率分别为9.76%、2.70%、26.83%、0.00%,明显低于对照组的31.71%、10.71%、56.10%、7.31%(P<0.05)。结论拉米夫定能减轻使用抗结核药物治疗肺结核合并乙型肝炎病毒携带所引起的肝损伤,具有较高的HBV-DNA阴转率和治愈率,且复发率、不良反应发生率和死亡率较低,值得应用推广。
Objective To investigate the efficacy of anti-tuberculosis drugs combined with lamivudine in patients with pulmonary tuberculosis and hepatitis B virus. Methods Eighty-two patients with pulmonary tuberculosis and hepatitis B virus who were diagnosed and treated from February 2010 to December 2013 were randomly divided into two groups. The control group was treated with the national recommended anti-tuberculosis drug treatment regimen, and the observation group was treated with lamivudine on the basis of the control group. At different time points after treatment, liver function, HBV-DNA negative conversion rate, cure rate, failure rate, recurrence rate, incidence of adverse reactions and mortality were compared between the two groups. Results After treatment, the total incidence of liver injury in the observation group was 19.51%, (98.42 ± 21.53) μL, (121.46 ± 26.38) μL / (31.62 ± 3.25) μmol / L , (17.42 ± 4.15) μmol / L were significantly lower than those in the control group (46.34%, 326.79 ± 143.92 μL, (453.27 ± 146.28) μL, (61.42 ± 13.79) μmol / L, 8.43) μmol / L, respectively (all P <0.05). One year follow-up, the cure rates of HBV-DNA negative conversion rate and tuberculosis in the observation group were 21.95% and 90.24%, which were significantly higher than those in the control group (4.88% , 68.29% (P <0.05). The failure rate, recurrence rate, adverse reaction rate and mortality were 9.76%, 2.70%, 26.83% and 0.00% respectively, which were significantly lower than those of the control group (31.71%, 10.71%, 56.10% , 7.31% (P <0.05). Conclusion lamivudine can reduce the use of anti-TB drugs in the treatment of tuberculosis and hepatitis B virus-borne liver injury, with high HBV-DNA negative conversion rate and cure rate, and the recurrence rate, the incidence of adverse reactions and mortality Lower, it is worth to promote.