初治肺结核伴慢性乙型肝炎病毒携带者抗结核药物的选择
|
摘要
目的:评价2HRZE/4HR和2HL2LfxE/4HL2两种方案治疗初治肺结核合并慢性乙型肝炎病毒携带者的疗效和安全性。方法:选取笔者所在医院2014年3月-2017年3月符合入选标准的初治肺结核合并慢性乙型肝炎病毒携带者160例作为研究对象,随机分试验组80例和对照组80例。最终资料完整的有153例,其中试验组78例,对照组75例,两组年龄、性别、病情严重程度相当,具有可比性(P>0.05)。对照组给予2HRZE/4HR的抗结核治疗方案,试验组给予2HL2LfxE/4HL2治疗方案。比较两组患者治疗后临床症状缓解时间、胸部CT病灶吸收情况、痰检转阴或转阳以及肝功能损害程度。结果:与对照组比较,试验组在症状缓解时间、胸部CT病灶吸收情况和痰菌阴转或阳转情况均无统计学差异(P>0.05);两组1年后胸部CT显示病灶均无复发且痰菌均为阴性。与对照组比较,试验组肝功能损伤较轻,两组比较差异有统计学意义(P<0.05)。结论:对于初治肺结核合并慢性乙型肝炎病毒携带,两种方案疗效相当,但2HL2LfxE/4HL2方案肝损害较轻,可作为临床首选方案。
Objective:To evaluate the efficacy and safety of two schemes,2 HRZE/4 HR and 2 HL2 LfxE/4 HL2,in the treatment of primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers.Method:160 patients,primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers who meet the inclusion criteria in our hospital from March 2014 to March 2017,were selected as the research objects,and were randomly divided into 80 patients in the experimental group and 80 patients in the control group.There were 153 patients with complete data,including 78 cases in the experimental group and 75 cases in the control group.The age,gender and severity of the disease in the two groups were comparable(P>0.05).The patients in control group were given 2 HRZE/4 HR anti-tuberculosis treatment scheme,while that in the experimental group were given 2 HL2 LfxE/4 HL2 treatment scheme.The clinical symptom relief time,chest CT lesion absorption,sputum negative or positive transformation and liver function damage were compared between the two groups.Result:Compared with the control group,there were no statistically significant differences in symptom relief time,chest CT lesion absorption and sputum negative or positive transfer in the experimental group(P>0.05).Chest CT showed no recurrence and negative sputum in both groups after 1 year.Compared with the control group,the liver function injury in the experimental group was relatively mild,and the difference between the two groups was statistically significant(P<0.05).Conclusion:The two schemes have equal efficacy for the primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers,but the2 HL2 LfxE/4 HL2 scheme has relatively mild liver damage,which can be used as first choice in the clinical practice.
Objective:To evaluate the efficacy and safety of two schemes,2 HRZE/4 HR and 2 HL2 LfxE/4 HL2,in the treatment of primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers.Method:160 patients,primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers who meet the inclusion criteria in our hospital from March 2014 to March 2017,were selected as the research objects,and were randomly divided into 80 patients in the experimental group and 80 patients in the control group.There were 153 patients with complete data,including 78 cases in the experimental group and 75 cases in the control group.The age,gender and severity of the disease in the two groups were comparable(P>0.05).The patients in control group were given 2 HRZE/4 HR anti-tuberculosis treatment scheme,while that in the experimental group were given 2 HL2 LfxE/4 HL2 treatment scheme.The clinical symptom relief time,chest CT lesion absorption,sputum negative or positive transformation and liver function damage were compared between the two groups.Result:Compared with the control group,there were no statistically significant differences in symptom relief time,chest CT lesion absorption and sputum negative or positive transfer in the experimental group(P>0.05).Chest CT showed no recurrence and negative sputum in both groups after 1 year.Compared with the control group,the liver function injury in the experimental group was relatively mild,and the difference between the two groups was statistically significant(P<0.05).Conclusion:The two schemes have equal efficacy for the primary treated pulmonary tuberculosis accompanied with chronic hepatitis B virus carriers,but the2 HL2 LfxE/4 HL2 scheme has relatively mild liver damage,which can be used as first choice in the clinical practice.
引文
[1]卫安娜,方怡,梁国添.抗结核药物性肝损伤临床危险因素分析[J].临床肺科杂志,2015,20(9):1556-1559.
[2] World Hralth Organization.WHO report 2009-Global tuberculosis control[EB/OL].2012-12-20.
[3]曹钦,李之清.抗结核药物致乙肝病毒标志物阳性患者死亡1例报道[J].中西医结核研究,2011,3(4):223-224.
[4]朱倬敏.抗结核药物对肺结核合并乙肝患者肝损伤的相关因素分析[J].医学理论与实践,2017,30(2):1-4.
[5]孙其志,范明宽,刘晓敏.肺结核患者合并感染乙型肝炎病毒状况调查[J].襄阳职业技术学院学报,2018,17(1):88-90.
[6]吕玉凤.两种不同化疗方案治疗肺结核合并乙型肝炎患者疗效及对肝功能的影响[J].实用肝脏病杂志,2014(5):493-496.
[7]中华人民共和国卫生行业标准:肺结核诊断标准[S].北京:人民卫生出版社.
[8]陆荫英,李晶.2015版《慢性乙型肝炎防治指南》解读之:HBV感染相关HCC的随访监测[J].中国肝脏病杂志,2015(3):36-39.
[9]兰小华.恩替卡韦治疗肺结核合并慢性乙型肝炎患者疗效观察[J].中国民康医学,2018,30(13):42-43.
[10]凌云涛,陶臻.抗结核药物对肺结核并乙肝病毒感染者肝损害的影响[J].西北药学杂志,2018,33(3):399-401.
[11]谢惠安,阳因太,林善梓.现代结核病学[M].北京:人民卫生出版社,2000:514-525.
[12]彭卫生,王英年,肖成志.新编结核病学[M].第2版.北京:中国医药科技出版社,2003:453-455.
[13]王巍,金关甫.结核病治疗药物研究新进展[J].传染病信息,2003,6(4):159-160.
[14]黄泽标.左氧氟沙星联合其他抗结核药物治疗肺结核的临床疗效分析[J].北方药学,2018,15(1):80-81.
[15] Lee B H,Koh W J,Choi M S,et al.Inactive hepatitis B surface antigen carrier state and hepatotoxicity during arttitubereulasis chemotherapy[J].Chest,2005,127(4):1304-1311.
[16]宁洪叶,蒋贤高,施伎蝉.左氧氟沙星及利福喷丁胶囊治疗老年初治肺结核患者的疗效及安全性分析[J].中国生化药物杂志,2017,17(4):238-240.
[17]覃红娟,谭守勇,邝浩斌,等.联合抗病毒治疗对肺结核HBVDNA阳性患者药物性肝损害的预防作用研究[J].岭南急诊医学杂志,2015,20(3):227-228.
[18]王景民,孙秀利,王新宏.肺结核合并慢性乙型肝炎患者抗结核治疗肝功能损害的临床分析[J].中国临床医生,2012,40(10):40.
[2] World Hralth Organization.WHO report 2009-Global tuberculosis control[EB/OL].2012-12-20.
[3]曹钦,李之清.抗结核药物致乙肝病毒标志物阳性患者死亡1例报道[J].中西医结核研究,2011,3(4):223-224.
[4]朱倬敏.抗结核药物对肺结核合并乙肝患者肝损伤的相关因素分析[J].医学理论与实践,2017,30(2):1-4.
[5]孙其志,范明宽,刘晓敏.肺结核患者合并感染乙型肝炎病毒状况调查[J].襄阳职业技术学院学报,2018,17(1):88-90.
[6]吕玉凤.两种不同化疗方案治疗肺结核合并乙型肝炎患者疗效及对肝功能的影响[J].实用肝脏病杂志,2014(5):493-496.
[7]中华人民共和国卫生行业标准:肺结核诊断标准[S].北京:人民卫生出版社.
[8]陆荫英,李晶.2015版《慢性乙型肝炎防治指南》解读之:HBV感染相关HCC的随访监测[J].中国肝脏病杂志,2015(3):36-39.
[9]兰小华.恩替卡韦治疗肺结核合并慢性乙型肝炎患者疗效观察[J].中国民康医学,2018,30(13):42-43.
[10]凌云涛,陶臻.抗结核药物对肺结核并乙肝病毒感染者肝损害的影响[J].西北药学杂志,2018,33(3):399-401.
[11]谢惠安,阳因太,林善梓.现代结核病学[M].北京:人民卫生出版社,2000:514-525.
[12]彭卫生,王英年,肖成志.新编结核病学[M].第2版.北京:中国医药科技出版社,2003:453-455.
[13]王巍,金关甫.结核病治疗药物研究新进展[J].传染病信息,2003,6(4):159-160.
[14]黄泽标.左氧氟沙星联合其他抗结核药物治疗肺结核的临床疗效分析[J].北方药学,2018,15(1):80-81.
[15] Lee B H,Koh W J,Choi M S,et al.Inactive hepatitis B surface antigen carrier state and hepatotoxicity during arttitubereulasis chemotherapy[J].Chest,2005,127(4):1304-1311.
[16]宁洪叶,蒋贤高,施伎蝉.左氧氟沙星及利福喷丁胶囊治疗老年初治肺结核患者的疗效及安全性分析[J].中国生化药物杂志,2017,17(4):238-240.
[17]覃红娟,谭守勇,邝浩斌,等.联合抗病毒治疗对肺结核HBVDNA阳性患者药物性肝损害的预防作用研究[J].岭南急诊医学杂志,2015,20(3):227-228.
[18]王景民,孙秀利,王新宏.肺结核合并慢性乙型肝炎患者抗结核治疗肝功能损害的临床分析[J].中国临床医生,2012,40(10):40.