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目的探讨水飞蓟宾联合替比夫定在预防乙型肝炎病毒(HBV)携带者抗结核治疗肝损害中的效果。方法 78例肺结核合并HBV携带者随机分为对照组39例和联合治疗组39例。两组均采用异烟肼、利福平、吡嗪酰胺、乙胺丁醇2个月强化期,异烟肼、利福平4个月巩固期(2HRZE/4HR)化疗和水飞蓟宾护肝治疗,联合治疗组同时给予替比夫定抗病毒治疗。观察两组治疗前后的肝功能与HBV DNA水平变化。结果联合治疗组不良事件发生率为17.95%,明显低于对照组(46.15%),差异有统计学意义(P<0.05)。两组治疗前肝功能和HBV DNA水平比较差异无统计学意义(P>0.05);治疗后,联合治疗组的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)和HBV DNA水平为(42.49±6.31)U/L、(41.37±6.83)U/L和(3.25±1.36)lg copies/ml,明显低于对照组[分别为(55.16±10.43)U/L、(54.62±9.51)U/L和(6.48±2.17)lg copies/ml],差异有统计学意义(P<0.05)。结论肺结核合并HBV携带者化疗时联合使用水飞蓟宾护肝治疗和替比夫定抗病毒治疗,能抑制HBV的复制,预防肝功能损害。
Objective To investigate the effect of silybin combined with telbivudine in the prevention of hepatitis B virus (HBV) carriers of anti-TB treatment of liver damage. Methods 78 cases of tuberculosis with HBV carriers were randomly divided into control group 39 cases and combined treatment group 39 cases. Both groups were treated with isoniazid, rifampicin, pyrazinamide, ethambutol for 2 months, isoniazid and rifampin for 4 months (2HRZE / 4HR) and silybin Liver treatment, the combination therapy group was given telbivudine antiviral therapy. The changes of liver function and HBV DNA level before and after treatment in both groups were observed. Results The incidence of adverse events in the combined treatment group was 17.95%, which was significantly lower than that in the control group (46.15%). The difference was statistically significant (P <0.05). There was no significant difference in liver function and HBV DNA level between the two groups before treatment (P> 0.05). After treatment, the levels of ALT, AST and HBV DNA in the combined treatment group were (42.49 ± 6.31) U / L, (41.37 ± 6.83) U / L and (3.25 ± 1.36) lg copies / ml were significantly lower than those in the control group [55.16 ± 10.43 U / L, 54.62 ± 9.51, U / L and (6.48 ± 2.17) lg copies / ml], the difference was statistically significant (P <0.05). Conclusions Combination chemotherapy with silybin and telbivudine antiviral therapy in patients with pulmonary tuberculosis and HBV carriers can inhibit HBV replication and prevent liver damage.