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

摘要

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 virolo-gy 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 A0.05). 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 A0.05). CONCLUSIONS:Tiopronin combined with lamivudine can significantly reduce liver function damage caused by an-ti-TB drugs. It is conducive to the smooth progress of tuberculosis chemotherapy with fewer adverse reactions.%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。