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目的评价拉米夫定联合还原型谷胱甘肽预防乙型病毒性肝炎(乙肝)合并肺结核患者肝功能损伤中的疗效。方法入选94例乙肝合并肺结核患者,分为试验组47例和对照组47例,试验组口服拉米夫定每次0.1 g,每天1次,联合还原型谷胱甘肽每次0.4 g,每天3次;对照组口服拉米夫定每次0.1 g,每天1次。观察2组患者治疗前后肝功能指标,肝纤维化指标,临床疗效及不良反应情况。结果治疗后,2组患者的谷草转氨酶、谷丙转氨酶、总胆汁酸、总胆红素、Ⅳ型胶原、层黏连蛋白、透明质酸酶、Ⅲ型前胶原均较治疗前有所下降(P<0.05),但试验组下降更明显(P<0.05)。治疗前,2组患者的HBV-DNA载量差异无统计学意义(P>0.05);治疗后3,6,10周,试验组HBV-DNA载量均显著低于对照组(P<0.05)。试验组临床总有效率显著高于对照组(P<0.05)。2组患者均无严重的不良反应发生。结论拉米夫定联合还原型谷胱甘肽预防乙肝合并肺结核患者肝功能损伤的临床疗效显著,肝功能恢复良好。
Objective To evaluate the efficacy of lamivudine combined with reduced glutathione in the prevention of liver injury in patients with hepatitis B and pulmonary tuberculosis. Methods Ninety-four patients with hepatitis B and pulmonary tuberculosis were enrolled and divided into experimental group (n = 47) and control group (n = 47). The experimental group received lamivudine 0.1 g once daily and combined with reduced glutathione 0.4 g per day 3 times; control group oral lamivudine 0.1 g, 1 times a day. Two groups of patients before and after treatment of liver function indicators, liver fibrosis indicators, clinical efficacy and adverse reactions. Results After treatment, aspartate aminotransferase, alanine aminotransferase, total bile acid, total bilirubin, type Ⅳ collagen, laminin, hyaluronidase and type Ⅲ procollagen in both groups were lower than those before treatment P <0.05), but the test group decreased more significantly (P <0.05). Before treatment, the HBV-DNA load of two groups had no significant difference (P> 0.05). After 3, 6 and 10 weeks of treatment, the HBV-DNA load of the experimental group was significantly lower than that of the control group (P <0.05) . The total effective rate of the experimental group was significantly higher than that of the control group (P <0.05). No serious adverse reactions occurred in both groups. Conclusion Lamivudine combined with reduced glutathione in the prevention of liver damage in patients with hepatitis B and pulmonary tuberculosis clinical efficacy was significant, good recovery of liver function.