复方甘草酸单胺辅治复治肺结核并存慢性乙型肝炎临床观察(附56例分析)福建医科大学教学医院福州肺科医院(350008)翁丽珍朱玉芳陈淑琴李学玲毛雅云刘坦业【中图分类号】【文献标识】B【文章编号】【摘要】目的观察复方甘草酸单胺(美能)在辅助治疗复治肺结核并存慢性乙型肝炎的临床疗效与不良反应。方法将56例复治肺结核并存慢性乙型肝炎者随机分为治疗组与对照组，在两组均投予有效抗结核治疗基础上，治疗组27例，加用美能；对照组29例，投予还原型谷胱甘肽。结果治疗2个月时，治疗组肝功能改善总有效率88.9%,对照组为62.7%(P<0.05),治疗组临床症状和体征消失率、明显改善率分别为37.0%和59.3%,对照组为27.6%和44.8%,两者比较有显著差界。加强期结束：治疗组病灶显吸率及痰菌阴转率分别为96.3%和95.6%,明显高于对照组的62.1%和48.0%。不良反应少。结论美能在复治肺结核并存慢性乙肝患者治疗过程屮能有效改善肝功能，保障顺利完成抗结核全程化疗。【关键词】结核、肺/药物治疗、慢性乙型肝炎/药物治疗、复方甘草酸单胺ClinicalObservationontheClinicalEfficacyofCompoundGlycyrrhizinintheTreatmentofTuberculosiswithRetreatedandChronicHepatitisB(Analysisof56Cases)ClinicalTeachingDivisionofFuzhouPulmonaryHospitslAffiliatedtoFujianMedicalUniversity(350008)WengLizhen,ZhuYufang,ChenShuqin,LiXueling,MaoYayun,LiuTanYe[Abstract]ObjectiveToobservetheclinicslefficacyandtheadversereactionsofCompoundGlycyrrhizin(StrongeTNeo-MinophagenC)inthetreatmentoftuberculosiswithretreatedandChronicHepatitisB.基金项目:福州市科技计划项目(2004-66)MethodsByrandomgroup-matching,56casesoftuberculosiswithretreatedandChronicHepatitisBweredividedintothetreatmentgroup(27cases)andcontrolgroup(29cases).Thebothgroupsweretreatedwitheffectiveantitubercuolsisdrugs.ThetreatmentgroupwastobetreatedwithStrongerNeo-MinophagenCwhilethecontrolgroupreducedglutathione.ResultsAftertwomonth'streatment,thetotaleffectiverateof1iverfunctionimprovementwas88.9%inthetreatmentgroup,and62.7%(P<0.05)inthecontrolgroup.Therateofclinicalsymptomandphysicalsigndisappearanceaswellasdistinctameliorationwererespectively37%and59.3%inthetreatmentgroup,andforthecontrolgroup27.6%and44.8%.Notabledifferencescouldbefoundincomparisonbetweenthetreatmentgroupandthecontrolgroupintheabovementionedaspects.Attheendoftheenhancedtreatmentperiod,theratesoftuberculosisfociabsorptionandthenegativesputumconversionwere93.6%and95.6%intreatmentgroup,whichweremuchhigherthanthoseofthecontrolgroupwhichwererespectively62.2%and48.0%.Adversereactionswererarelyfound.ConeIusionStrongerNeo-MinophagenCiseffectiveandreliableinimproving1iverfunctionandensuringthesuccessofthewholeprocessofanti-tuberculosischemotherapyforpatientssufferingfromtuberculosiswithretreatedandChronicHepatitisB.[Keywords】Tuberculosis、Pulmonary/drugtherapy、ChronicHepatitisB/drugtherapy、CompoundGlycyrrhizin抗结核药物对肝脏均有一定毒性作用，尤其对乙肝患者抗结核过程屮出现肝功损害率高达50%。药物性肝炎约50%、70%在用药2周内发生，80%~90%在用药8周内发病[\为此，常使抗结核治疗被迫屮止而导致耐药。本课题选用甘草酸单胺联合抗结核药治疗慢性乙肝并复治肺结核的患者取得效果，现报告如下：1对象与方法1.1对象选2004年1月〜2006年10月住院及门诊患者60例，全部病例均符合《临床诊疗指南结核病分册》⑵及全国病毒性肝炎西安会议所制定的临床诊断标准(2000年)[3：o同时要求：⑴年龄在18岁以上，复治肺结核并慢性乙型肝炎的患者；⑵乙肝病毒标志物：乙型肝炎病毒表面抗原(HBsAg)、乙型肝炎病毒e抗原(HBeAg)、乙型肝炎病毒e抗体(HBeAb)、乙型肝炎病毒核心抗体(HBcAb).乙型肝炎病焉DNA(HBV-DNA)二项以上阳性，肝功能ALT在正常值上限1倍以上(96u/1)...