不同治疗方案的恩替卡韦联合抗结核药物治疗肺结核合并慢性乙肝的临床疗效及安全性<sup>*</sup>

doi:10.3969/j.issn.1671-7171.2025.06.004

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摘要【目的】探讨不同治疗方案的恩替卡韦联合抗结核药物治疗肺结核合并慢性乙型肝炎(乙肝)的临床疗效及安全性。【方法】回顾性分析2021年1月至2023年6月江西省胸科医院收治的120例初治肺结核合并慢性乙肝患者的临床资料,根据治疗方案的不同将患者分为对照组(n=32)、观察A组(n=47)、观察B组(n=41)。比较三组患者治疗效果和不良反应发生率,三组治疗前后血清总胆红素(TBIL)、谷丙转氨酶(ALT)、谷氨酰转肽酶(GGT)水平,三组治疗前、治疗6个月、治疗12个月、停药3个月的HBV-DNA水平。【结果】观察A组、观察B组临床总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,观察A组、观察B组血清TBIL、ALT水平高于治疗前,GGT水平低于治疗前,血清TBIL、ALT、GGT水平均低于对照组,差异有统计学意义(P<0.05)。治疗6个月、治疗12个月、停药3个月,观察A组、观察B组HBV-DNA水平均低于对照组,差异有统计学意义(P<0.05)。三组不良反应总发生率比较,差异无统计学意义(P>0.05)。【结论】肺结核合并慢性乙肝服用抗结核药物在按照“早期、规律、联合、适量和全程”的原则治疗后,继续服用抗病毒药物临床疗效会更佳,且安全性较好。

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关键词 ：结核, 肺, 乙型肝炎, 慢性, 抗病毒药, 抗结核药, 治疗结果

Abstract：【Objective】 To explore the clinical efficacy and safety of entecavir combined with antitubercular drugs in different treatment regimens for pulmonary tuberculosis complicated with chronic hepatitis B.【Methods】 A retrospective analysis was performed on the clinical data of 120 newly diagnosed patients with pulmonary tuberculosis complicated with chronic hepatitis B admitted to Jiangxi Chest hospital from January 2021 to June 2023. According to different treatment regimens, the patients were divided into the control group (n=32),the observation group A (n=47), and the observation group B (n=41). The treatment efficacy and incidence of adverse reactions were compared among the three groups. The levels of serum total bilirubin (TBIL), alanine aminotransferase (ALT), and gamma-glutamyl transpeptidase (GGT) were compared before and after treatment. The HBV-DNA levels were compared before treatment, at 6 months, 12 months of treatment, and 3 months after drug withdrawal. 【Results】 The total clinical effective rates of observation group A and observation group B were higher than that of the control group, with statistically significant differences (P<0.05). After treatment, the serum TBIL and ALT levels in observation group A and observation group B were higher than those before treatment, the GGT levels were lower than those before treatment, and the serum TBIL, ALT, and GGT levels were all lower than those in the control group, with statistically significant differences (P<0.05). At 6 months, 12 months of treatment, and 3 months after drug withdrawal, the HBV-DNA levels in observation group A and observation group B were lower than those in the control group, with statistically significant differences (P<0.05). The incidences of adverse reactions in the three group were no significant differences (P>0.05). 【Conclusion】 For patients with pulmonary tuberculosis complicated with chronic hepatitis B taking antitubercular drugs, continuing antiviral therapy after treatment according to the principles of "early, regular, combined, appropriate, and full-course" can achieve better clinical efficacy and better safety.

Key words： Tuberculosis, Pulmonary Hepatitis B, Chronic Antiviral Agents Antitubercular Agents Treatment Outcome

收稿日期: 2025-03-31

中图分类号:

R521

基金资助:*江西省卫健委科技计划项目(202130961)

通讯作者: **E-mail:13217003365@163.com

引用本文:

廖永美, 蔡国庆, 李娟, 代亮, 刘邹. 不同治疗方案的恩替卡韦联合抗结核药物治疗肺结核合并慢性乙肝的临床疗效及安全性^*[J]. 医学临床研究, 2025, 42(6): 923-926.
LIAO Yongmei, CAI Guoqing, LI Juan, et al. Clinical Efficacy and Safety of Entecavir Combined with Antitubercular Drugs in Different Treatment Regimens for Pulmonary Tuberculosis Complicated with Chronic Hepatitis B. JOURNAL OF CLINICAL RESEARCH, 2025, 42(6): 923-926.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.06.004 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I6/923

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