关键词: 结核, 肺/药物疗法, 结核, 肺/并发症, 临床方案, 肝炎, 乙型, 慢性

Abstract: Objective To observe the efficacy and hepatic function in patients with pulmonary tuberculosis combined with type B hepatitis treated by three regimens and to provide the evidence for the treatment option. Methods 128 patient with pulmonary tuberculosis combined with type B hepatitis were randomly assigned to three groups including A group received the standard regimen with 2HREZ/7HRE(n=44), B group received 9HL2E in which levofloxacin was used in intensive(n=42) stage and C group received 2HREZ/7HRE and lamivudine(n=42). The X-ray resorption rate, the sputum negative conversion rate, Hepatic function and HBV DNA were observed over the course of treatment. Results The withdrawl rates of A, B and C goups were 40.9%（18/44）,11.9%（5/42）and 8.9%（5/56）（χ²=18.22，P<0.01）, the sputum negative conversion rate were 53.8%（14/26）,81.1%（30/37）and 90.0%（36/40）, the X-ray resorption rates were 38.5%（10/26）,62.2%（23/37）and 70.0%（28/40）（χ²=7.04-4.46，P<0.01 or P<0.05）. When the course of treatment was over, alanine transaminase(ALT)were （0.73±0.37）μmol·s^－1·L^－1, （0.68±0.30）μmol·s^－1·L^－1 and （0.47±0.14）μmol·s^－1·L^－1（t=4.39，P<0001）,Aspartate transaminase(AST) were （0.68±0.33）μmol·s^－1·L^－1, （0.65±0.32）μmol·s^－1·L^－1 and （0.42±0.13）μmol·s^－1·L^－1（t=4.63，P<0.001） in A, B and C group, respectively.  Total bilirubin(TB) were （17±4.38）μmol/L, （16±4.01）μmol/L and （13±4.21）μmol/L（t=9.97，P<0.001），HBV DNA were （6.3±0.6）log copy/ml, （6.1±0.8）log copy/ml and （3.1±0.4） log copy/ml（t=378.65，P<0.001）in A, B and C group, respectively. There were statistical significance between group A, B and group C. Conclusion In patients with pulmonary tuberculosis combined with type B hepatitis, B group and C group had better efficacy and was safety with lower rate of hepatic lesion and tolerable.

Key words: Tuberculosis,pulmonary/drug therapy, Tuberculosis,pulmonary/complications, Clinical protocols, Hepatitis B,chronic