恩替卡韦治疗慢性乙型肝炎合并肺结核的疗效分析

朱红欣

[摘要] 目的 觀察慢性乙型肝炎合并肺结核应用恩替卡韦治疗的临床效果。 方法 收集62例慢性乙型肝炎合并肺结核患者作为研究对象，就诊时间为2014年1月～2016年7月，随机分为观察组和对照组各31例，两组均使用相同的抗结核初治方案，此外，观察组使用恩替卡韦片治疗。比较两组治疗前后肝功能指标及 HBV-DNA水平。结果 肝功能指标：治疗后两组ALB、ALT、TBIL水平均明显降低，与治疗前比较，差异有统计学意义（P<0.05），治疗后观察组ALB、ALT、TBIL水平与对照组比较更低，两组差异有统计学意义（P<0.05）。HBV-DNA水平：治疗后两组HBV-DNA水平均明显降低，与治疗前比较，差异有统计学意义（P<0.05），治疗后观察组HBV-DNA水平与对照组比较更低，两组差异有统计学意义（P<0.05）。 结论 恩替卡韦对慢性乙型肝炎并肺结核患者肝功能有显著的改善作用，可显著抑制病毒复制，建议在慢性乙型肝炎合并肺结核患者中推广应用。

[关键词] 慢性乙型肝炎；肺结核；恩替卡韦；肝功能

[中图分类号] R512.62 [文献标识码] B [文章编号] 1673-9701（2017）14-0097-03

[Abstract] Objective To observe the clinical efficacy of the application of entecavir in the treatment of chronic hepatitis B complicated with pulmonary tuberculosis. Methods A total of 62 patients with chronic hepatitis B complicated with pulmonary tuberculosis were collected as the research subjects. They were diagnosed from January 2014 to July 2016. They were randomly assigned to the observation group and the control group， with 31 patients in each group. Both groups were given the same initial treatment protocol of anti-tuberculosis. In addition， the observation group was given entecavir tablets. The liver function indices and HBV-DNA level between two groups were compared before and after the treatment. Results Liver function indices： ALB， ALT and TBIL levels were significantly decreased in both groups after the treatment， and the differences were statistically significant compared with those before the treatment （P<0.05）. ALB， ALT and TBIL levels in the observation group after the treatment were even lower than those in the control group， and the differences between the two groups were statistically significant（P<0.05）. HBV-DNA level： HBV-DNA level in both groups after the treatment was significantly decreased， and the difference was statistically significant compared with that before the treatment （P<0.05）. HBV-DNA level in the observation group after the treatment was even lower than that in the control group， and the difference between the two groups was statistically significant （P<0.05）. Conclusion Entecavir has a significant improving effect on the liver function in the patients with chronic hepatitis B complicated with pulmonary tuberculosis， which can greatly inhibit the replication of virus. It is suggested that the application of entecavir be popularized in the patients with chronic hepatitis B complicated with pulmonary tuberculosis.

[Key words] Chronic hepatitis B； Pulmonary tuberculosis； Entecavir； Liver function

慢性乙型肝炎和肺结核均为临床常见疾病，全世界约有3.5亿慢性乙肝病毒（HBV）携带者，我国是乙型肝炎病毒感染的高流行区，慢性乙型肝炎患者约2000万例[1]。肺结核是由结核分枝杆菌引起的慢性传染性疾病，可侵袭机体多个器官[2]。部分肺结核患者同时还患有慢性乙型肝炎，与单纯肺结核患者比较，慢性乙型肝炎合并肺结核患者由于体内肝炎病毒的存在，接受抗结核治疗后发生肝脏炎性损伤的几率更高，程度也更重，使患者的肝功能损害进一步加重[3]。因此，合理治疗方案的选择是治疗慢性乙型肝炎合并肺结核患者的关键措施。本研究对31例慢性乙型肝炎合并肺结核患者使用恩替卡韦治疗，效果较满意，现报道如下。

1 资料与方法

1.1 一般资料

收集62例慢性乙型肝炎合并肺结核患者作为研究对象，就诊时间为2014年1月～2016年7月，符合《病毒性肝炎防治方案》[4]、《临床诊疗指南·结核病分册》[5]中相应的诊断标准。……