关键词: 结核, 肺/药物疗法, 肝炎, 乙型, 带病原状态, 拉米夫定, 抗结核药, 药物疗法, 联合

Abstract: Objective To explore the effect of lamivudine therapy on pulmonary tuberculosis patients with hepatitis B virus carriers based on anti-TB treatment, including the incidence of liver injury, the treatment time and long-term effects.  Methods One hundred and forty-two new pulmonary tuberculosis patients with chronic hepatitis B virus carriers who had normal liver function were randomly divided into lamivudine group (73 patients, 4 cases were lost to follow-up) and control group (69 patients, 6 cases were lost to follow-up). By the end of 18-month treatment, lamivudine would be stopped, but anti-tuberculosis drugs were not stopped until the treatment ended. All the patients of both groups were followed up for 24 months, liver injury rate within 4 weeks,the total liver injury rate, HBV-DNA negative rate, mortality, TB cure rate, failure rate were analyzed by Chi-square test or Fisher’s exact probability method. Results Patients treated with lamivudine significantly reduced liver injury. Liver injury rate within 4 weeks, the total liver injury rate and mortality of the lamivudine group were lower than the control group. There were significant differences between lamivudine group （4.3%（3/69）,20.3%（14/69）,0.0%（0/69）; P=0.007, 0.0001, 0.023, χ²=7.064，15.176) and control group （19.0% (12/63)，49.2% (31/63)，7.9% (5/63)）. At the end of TB treatment and the end of follow-up period, the HBV-DNA negative rate of lamivudine group （24.6%（17/69），21.7%（15/69）） was higher than control group （3.2%（2/63），3.2%（2/63））, the dif-ference was statistically significant (χ²=12.311，P=0.0005；andχ²=10.115，P=0.001). TB cure rate of lamivudine group was higher than control group (89.9% vs 73.0%) and the failure rate lamivudine group were lower than the control group (4.3% vs 17.5%), There were significant differences between 2 groups.   Conclusion Using lamivudine within 18 months is relatively safe for reducing the incidence of hepatitis B, which has a long-term effect. Our findings can provide a clinic basis for prophylactic lamivudine therapy on pulmonary tuberculosis patients with HBV infection.

Key words: Tuberculosis, pulmonary/drug therapy, Hepatitis B, Carrier state, Lamivudine, Antitubercular agents, Drug therapy, combination