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硫普罗宁联合拉米夫定在肺结核合并慢性乙型肝炎治疗中的作用
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| 篇名： | 硫普罗宁联合拉米夫定在肺结核合并慢性乙型肝炎治疗中的作用 |
| TITLE： | |
| 摘要： | 目的：探讨硫普罗宁联合拉米夫定在肺结核合并慢性乙型肝炎（以下简称“乙肝”）治疗中的作用及安全性。方法：将150例确诊为肺结核合并慢性乙肝的患者按随机数字表法分为A组（药物联合组）、B组（拉米夫定组）、C组（对照组），各50例。3组患者均采用异烟肼+利福喷丁+乙胺丁醇+左氧氟沙星（2HTELfx/4HT）方案进行抗结核治疗及常规保肝药物治疗等；B组患者在此基础上口服拉米夫定片0.1 g，qd；A组患者在B组治疗基础上加服硫普罗宁片0.3 g，tid。3组患者疗程均为6个月。观察3组患者治疗前后的肝损伤情况、血清纤维化指标与治疗后的乙肝病毒学指标、临床疗效和不良反应发生情况。结果：治疗后，C组患者血清ALT、AST、TBIL水平较治疗前明显升高，A组患者上述指标水平较治疗前明显降低，差异均有统计学意义（P＜0.05）；B组患者上述指标与治疗前比较差异无统计学意义（P＞0.05）；治疗后血清ALT、AST、TBIL水平A组＜B组＜C组，差异均有统计学意义（P＜0.05）。 3组患者治疗后HBsAg转阴率、HBeAg转阴率与HBV-DNA转阴率比较，差异均无统计学意义（P＞0.05）。C组患者各项血清纤维化指标水平与治疗前比较，差异均无统计学意义（P＞0.05）；A、B组患者各项血清纤维化指标水平均较治疗前明显降低，差异均有统计学意义（P＜0.05）；治疗后各项血清纤维化指标水平A组＜B组＜C组，差异均有统计学意义（P＜0.05）。A、B、C组患者的总有效率分别为94.00％、76.00％、62.00％，组间比较差异有统计学意义（P＜0.05）；不良反应发生率分别为14.00％、16.00％、30.00％，组间比较差异无统计学意义（P＞0.05）。结论：硫普罗宁联合拉米夫定能明显减轻抗结核药物对患者肝功能的损伤，有利于肺结核治疗的顺利进行，且不良反应较少。 |
| ABSTRACT： | OBJECTIVE： To investigate clinical efficacy and safety of tiopronin combined with lamivudine in the treatment of pulmonary tuberculosis complicated with chronic hepatitis B. METHODS： 150 cases diagnosed as pulmonary tuberculosis with chronic hepatitis B were randomly divided into group A （drug combination group）， group B （lamivudine group） and the group C （control group）， with 50 cases in each group. 3 groups were given isoniazid+rifapentine+ethambutol+levofloxacin （2HTELfx/4HT） anti-TB treatment and liver protection treatment， etc. Group B was additionally given Lamivudine tablet orally， 0.1 g， qd； group A was additionally given Tiopronin tablet 0.3 g， tid， on the basis of group B. The treatment course of 3 groups lasted for 6 months.Liver damage，serum fibrosis indexes of 3 groups were observed in 3 groups before and after treatment as well as hepatitis B virology indexes， clinical efficacy and the occurrence of ADR after treatment. RESULTS： After treatment，serum levels of ALT， AST and TBIL weresignificantly increased in group C， significantly decreased in group A， with statistical significance （P＜0.05）.There was no statistical significance in above indexes of group B before and after treatment （P＞0.05）. Serum levels of ALT， AST and TBIL after the treatment： group A＜group B ＜group C ， with statistical significance（P＜0.05）. There were no significant difference in the negative rate of HBsAg， the negative rate of HBeAg， the negative rate of HBV-DNA among 3 groups after treatment （P＞0.05）. Serum fibrosis indexes of group A and B decreased significantly compared to before treatment， with statistical significance （P＜0.05）；serum fibrosis indexes after the treatment： group A＜group B ＜group C， with statistical significance （P＜0.05）. The total effective rate were 94.00％， 76.00％ and 62.00％ respectively in group A， group B and group C， with statistical significance （P＜0.05）. The incidence of ADR were 14.00％，16.00％ and 30.00％ respectively，without statistical significance （P＞0.05）. CONCLUSIONS： Tiopronin combined with lamivudine can significantly reduce liver function damage caused by anti-TB drugs. It is conducive to the smooth progress of tuberculosis chemotherapy with fewer adverse reactions. |
| 期刊： | 2016年第27卷第29期 |
| 作者： | 王飞，康定理，胡秀琼，李芳，高红英 |
| AUTHORS： | WANG Fei，KANG Dingli，HU Xiuqiong，LI Fang，GAO Hongying |
| 关键字： | 硫普罗宁；拉米夫定；肺结核；慢性乙型肝炎；肝损伤 |
| KEYWORDS： | Tiopronin； Lamivudine； Pulmonary tuberculosis； Chronic hepatitis B； Liver damage |
| 阅读数： | 370 次 |
| 本月下载数： | 2 次 |
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