应重视乙型肝炎合并肺结核的临床诊断与治疗

Antiviral treatment of mild chronic hepatitis B patients with tuberculosis: A controlled study

AIM

To observe the clinical efficacy of entecavir against hepatitis B virus (HBV) in patients with mild chronic hepatitis B (CHB) and pulmonary tuberculosis (PTB).

METHODS

Eight-two cases mild chronic hepatitis B patients with tuberculosis were chosen between January 2010 and December 2016. After liver biopsy, they were randomly divided into an antiviral treatment group (41 cases) and an antituberculosis therapy group (41 cases). The antiviral treatment group was treated with entecavir, and after 2 wk, it was combined with 2HREZ/4HR for antituberculosis treatment. The antituberculosis therapy group was treated with 2HREZ/4HR only. The course of treatment in both groups was 6 mo. Oral silybin and compound glycyrrhizin were given in both groups. After treatment, therapeutic efficacy and safety were compared between the two groups.

RESULTS

All the 82 cases underwent liver biopsy, which showed that 22 (26.8%) cases had G1 grade inflammation and 49 (59.8%) cases had a fibrosis level ≥ S₂. The levels of ALT and Tbil were comparable between after and before treatment in the two groups. However, the HBV DNA significantly declined at 4, 12, and 24 wk after antiviral treatment (P < 0.05), and HBV DNA in the antiviral treatment group was significantly lower than that in the antituberculosis therapy group. After treatment, HBV DNA negative conversion rate (95.1% vs 0%), liver damage (14.6% vs 46.3%), and the rate of discontinuing antituberculosis treatment due to adverse reactions (9.8% vs 34.2%) were significantly better in the antiviral treatment group than in the antituberculosis therapy group (P < 0.05).

CONCLUSION

For mild chronic hepatitis B patients with tuberculosis, entecavir treatment can reduce the incidence of liver adverse reactions to antituberculosis treatment, decrease HBV DNA level, reduce the discontinuation of antituberculosis therapy, and improve the clinical compliance to antituberculosis treatment.

Antiviral treatment of mild chronic hepatitis B patients with tuberculosis: A controlled study

AIM

To observe the effects of entecavir in treating mild chronic hepatitis B in patients with tuberculosis.

METHODS

Eight-two cases mild chronic hepatitis B patients with tuberculosis were chosen between January 2010 and December 2016. After liver biopsy, they were randomly divided into an antiviral treatment group (41 cases) and an antituberculosis therapy group (41 cases). The antiviral treatment group was treated with entecavir, and after 2 wk, it was combined with 2HREZ/4HR for antituberculosis treatment. The antituberculosis therapy group was treated with 2HREZ/4HR only. The course of treatment in both groups was 6 mo. Oral silybin and compound glycyrrhizin were given in both groups. After treatment, therapeutic efficacy and safety were compared between the two groups.

RESULTS

All the 82 cases underwent liver biopsy, which showed that 22 (26.8%) cases had G1 grade inflammation and 49 (59.8%) cases had a fibrosis level ≥ S₂. The levels of ALT and Tbil were comparable between after and before treatment in the two groups. However, the HBV DNA significantly declined at 4, 12, and 24 wk after antiviral treatment (P < 0.05), and HBV DNA in the antiviral treatment group was significantly lower than that in the antituberculosis therapy group. After treatment, HBV DNA negative conversion rate (95.1% vs 0%), liver damage (14.6% vs 46.3%), and the rate of discontinuing antituberculosis treatment due to adverse reactions (9.8% vs 34.2%) were significantly better in the antiviral treatment group than in the antituberculosis therapy group (P < 0.05).

CONCLUSION

For mild chronic hepatitis B patients with tuberculosis, entecavir treatment can reduce the incidence of liver adverse reactions to antituberculosis treatment, decrease HBV DNA level, reduce the discontinuation of antituberculosis therapy, and improve the clinical compliance to antituberculosis treatment.