Efficacy of different therapeutic schemes in patients with pulmonary tuberculosis and hepatitis B and their effect on liver function

Abstract

Objective To find out the therapeutic scheme which was effective and made less injury for liver in patients with pulmonary tuberculosis complicated with hepatitis B. Methods The clinical data of patients with pulmonary tuberculosis and hepatitis B who received combination therapy of 3HLVE/6HLE (H: isoniazid; L: rifapentine; V: levofloxacin; E: ethambutol) or 3HRZE/6HRE (R: rifampicin; Z: pyrazinamide) in Qingdao Chest Hospital from January, 2010 to December, 2013 were collected and analyzed retrospectively. The patients were divided into the observation group and the control group. The patients in the observation group received combination therapy of 3HLVE/6HLE (H, L, V, and E were given for 3 months as the intensifying period and then H, L, and E for 6 months as a consolidation period), while the patients in the control group received combination therapy of 3HRZE/6HRE (H, R, Z, and E were given for 3 months as the intensifying period and then H, R, and E for 6 months as the consolidation period). The patients in the 2 groups received silibinin capsules at the same time. The patients'serum alanine aminotransferase (ALT) levels, serum total bilirubin (TBil) levels, the sputum bacterial negative conversion rate, and the efficiency of lesion absorption after 3 or 6 months of treatments were recorded and the incidence of liver injury and efficacy of anti-tuberculosis scheme between the 2 groups were compared. Results A total of 102 patients in accordance with the inclusion criteria were collected. Of them, 50 cases were in the observation group and 52 cases in the control group. There were no statistically significant differences in patients'age, gender distribution and tuberculosis lesions between the 2 groups (P>0.05). The incidence of liver injury in the observation group (26.0%, 13/50) was lower than that in the control group (46.2%, 24/52) (P 0.05). After 3 or 6 months of treatment, the differences of the efficiency of lesion absorption between the 2 groups was not statistically significant (P>0.05). Conclusion Anti-tuberculosis scheme of 3HLVE/6HLE was a better therapeutic scheme in the early stage in patients with pulmonary tuberculosis and hepatitis B, which was more effective and made less liver injury. Key words: Antitubercular Agents; Tuberculosis; Hepatitis B; Drug-induced liver injury