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目的观察肺结核并HBV携带初治患者抗结核治疗的同时核苷类似物抗病毒治疗的临床效果。方法将肺结核并HBV携带者随机分为A、B、C组,每组30例。A组抗结核治疗(2HREZ/4HR)的同时予拉米夫定或者恩替卡韦抗病毒及甘草酸二胺肠溶胶囊护肝治疗,B组抗结核治疗(2HREZ/4HR)的同时予甘草酸二胺肠溶胶囊护肝治疗,C组仅给予抗结核治疗(2HREZ/4HR),比较3组患者肝功能受损情况、HBV-DNA变化情况。结果 A组肝损率较B组和C组低,差异均具有统计学意义(P<0.05);B组肝损率较C组低,差异有统计学意义(P<0.05);A组治疗后2月、6月HBV-DNA水平较治疗前明显下降,差异有统计学意义(P=0.000);B、C组治疗后6月HBV-DNA水平较治疗前无明显下降,差异无统计学意义(P=0.476、0.941)。结论对肺结核并HBV携带者早期予核苷类似物抗病毒治疗,能有效抑制HBV-DNA复制,减少肝功能损伤发生率,从而顺利完成抗结核治疗疗程,可广泛应用于临床。
Objective To observe the clinical effect of antiviral treatment of nucleoside analogues while treating patients with tuberculosis and HBV-borne anti-TB therapy. Methods Pulmonary tuberculosis and HBV carriers were randomly divided into A, B and C groups, 30 cases in each group. A group of anti-TB treatment (2HREZ / 4HR) at the same time to lamivudine or entecavir antiviral and glycyrrhizic acid enteric-coated capsules liver treatment, B group anti-TB treatment (2HREZ / 4HR) while glycyrrhizic acid diamine Enteric-coated capsule treatment of liver, C group only given anti-tuberculosis treatment (2HREZ / 4HR), compared the three groups of patients with impaired liver function, HBV-DNA changes. Results The liver injury rate of group A was lower than that of group B and group C (P <0.05). The liver damage rate of group B was lower than that of group C (P <0.05) The levels of HBV-DNA in two months and six months after the treatment were significantly lower than those before treatment (P = 0.000). The levels of HBV-DNA in B and C groups after 6 months of treatment were not significantly lower than those before treatment, with no significant difference Significance (P = 0.476, 0.941). Conclusions Antiviral treatment of nucleoside analogues in patients with pulmonary tuberculosis and HBV carriers can effectively inhibit HBV-DNA replication and reduce the incidence of hepatic injury, which can lead to the successful completion of antituberculosis treatment and can be widely used clinically.