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目的观察阿德福韦酯对肺结核并慢性乙型肝炎(CHB)患者作用。方法标准化疗的39例肺结核并CHB患者,随机分成阿德福韦酯抗病毒治疗组20例,对照组19例。两组患者均随访至3.5年。观察肺结核并CHB患者化疗中,阿德福韦酯抗病毒治疗与肝功能变化以及患者预后的相关性。结果化疗中,肺结核并CHB抗病毒组,肺结核并CHB未抗病毒组,肺结核并HBV-DNA阴性、其它HBV-M阳性组,单纯肺结核组,肝功能受损率分别为33.33%,94.74%,10.00%及5.07%。随访至3.5年,肺结核并CHB未抗病毒组,死亡7例(36.84%),且死亡与肝病直接相关(肝衰竭),发生肝硬化3例;肺结核并CHB抗病毒组,无肝硬化及死亡病例。结论肺结核并CHB,化疗中应用阿德福韦酯抗病毒有重要意义。阿德福韦酯抗HBV治疗,对改善肺结核CHB患者预后有重要作用,并有CHB的肺结核患者,建议化疗中常规联用阿德福韦酯抗HBV治疗。
Objective To observe the effect of adefovir dipivoxil on patients with pulmonary tuberculosis and chronic hepatitis B (CHB). Methods Thirty-nine patients with CHB who were treated with standard chemotherapy were randomly divided into adefovir dipivoxil treatment group (n = 20) and control group (n = 19). Two groups of patients were followed up to 3.5 years. Observe the correlation between adefovir dipivoxil antiviral therapy and liver function change and prognosis of patients with tuberculosis and CHB. Results In the chemotherapy group, the rates of liver dysfunction were 33.33%, 94.74%, 33.33%, respectively, in patients with pulmonary tuberculosis and CHB antiviral group, pulmonary tuberculosis without CHB antiviral group, pulmonary tuberculosis and HBV-DNA negative, 10.00% and 5.07% respectively. During the follow-up of 3.5 years, there were 7 cases (36.84%) died of pulmonary tuberculosis and CHB without antiviral group. The death was directly related to liver disease (liver failure), and 3 cases were caused by cirrhosis. In patients with pulmonary tuberculosis and CHB antiviral group, there was no cirrhosis and death Case. Conclusions The application of adefovir dipivoxil to tuberculosis and CHB and chemotherapy is of great significance. Adefovir dipivoxil anti-HBV treatment, to improve the prognosis of patients with pulmonary tuberculosis CHB play an important role, and patients with tuberculosis of CHB, chemotherapy is advised to routinely associated with adefovir dipivoxil treatment.