目的：探讨清热八味胶囊联合恩替卡韦对初治菌阳肺结核合并慢性乙型肝炎（chronic hepatitis B,CHB）患者的治疗效果。方法：选取2021年8月—2022年8月湖南师范大学附属胸科医院/湖南省胸科医院收治的106例初治菌阳肺结核合并CHB患者,随机分为两组,每组53例。两组均采取抗结核药物治疗,同时对照组采用恩替卡韦治疗,观察组采用清热八味胶囊联合恩替卡韦治疗。比较两组临床疗效、治疗前后肝功能[谷草转氨酶（aspartate aminotransferase,AST）、总胆红素（total bilirubin,TBil）、谷丙转氨酶（alanine aminotransferase,ALT）]、肺功能[一氧化碳弥散量（diffusing capacity of the lungs for carbon monoxide,DLCO）、肺总量（total lung capacity,TLC）、第1秒用力呼气容积实测值占预计值百分比（percentage of measured forced expiratory volume in one second to predicted value,FEV1%）、肺活量（lung capacity,VC）]及乙型肝炎病毒（HBV）-DNA载量、T辅助细胞（Th）1/Th2细胞因子[干扰素γ（interferon-γ,IFN-γ）、白介素-2（interleukin-2,IL-2）、IL-4]、血清转化生长因子-β1（transforming growth factor-β1,TGF-β1）水平变化。结果：观察组治疗6个月后总有效率（94.34%）高于对照组（73.58%）;治疗6个月后观察组血清ALT、AST、TBil、IL-4、TGF-β1水平与HBV-DNA载量较对照组均降低,IFN-γ、IL-2水平较对照组升高;治疗6个月后,观察组TLC、DLCO、FEV₁%、VC水平与对照组比较差异无统计学意义;观察组肝损害发生率（7.55%）低于对照组（30.19%）;观察组不良反应发生率（20.75%）与对照组（30.19%）比较差异无统计学意义。结论：清热八味胶囊联合恩替卡韦治疗肺结核合并CHB疗效确切,能降低HBV-DNA载量,改善肝功能,且能改善患者机体Th1/Th2免疫平衡。

Objective To investigate the therapeutic effect of Qingre Bawei capsules combined with entecavir on initial diagnosed bacterially-positive pulmonary tuberculosis patients with chronic hepatitis B (CHB). Methods A total of 106 patients with initial diagnosed of pulmonary tuberculosis and CHB, admitted to the Chest Hospital affiliated to Hunan Normal University/Hunan Provincial Chest Hospital from August 2021 to August 2022, were randomly divided into two groups, with 53 cases in each group. Both groups were treated with anti-tuberculosis drugs, while the control group was treated with entecavir, and the observation group was treated with Qingre Bawei capsules combined with entecavir. The clinical efficacy was compared between two groups, as well as changes in liver function [aspartate aminotransferase (AST), total bilirubin (TBil), alanine aminotransferase (ALT)], lung function [diffusing capacity of the lungs for carbon monoxide (DLCO), total lung capacity (TLC), percentage of measured forced expiratory volume in one second to predicted value (FEV₁%), lung capacity (VC)], hepatitis B virus (HBV)-DNA load, T helper cell (Th) 1/Th2 cytokines [Interferon-γ (IFN-γ), interleukin-2 (IL-2), interleukin-4 (IL-4)], and serum transforming growth factor-β1 （TGF-β1） levels before and after treatment. Results The total effective rate of the observation group after 6 months of treatment was 94.34%, which was higher than that of the control group's 73.58%. After 6 months of treatment, the levels of serum ALT, AST, TBil, IL-4, and TGF-β1 as well as the HBV-DNA load in the observation group were decreased compared to the control group, while the levels of IFN-γ and IL-2 were increased compared to the control group. After 6 months of treatment, there was no significant difference in the levels of TLC, DLCO, FEV1%, and VC between the observation group and the control group. The incidence of liver damage in the observation group was 7.55%, which was lower than that in the control group's 30.19%. The incidence of adverse reactions in the observation group was 20.75%, which was not significantly different from the control group's 30.19%. Conclusion The Qingre Bawei capsule, in combination with entecavir, demonstrates a reliable therapeutic effect in treating tuberculosis combined with CHB. It can reduce the HBV-DNA load, improve liver function, and enhance the Th1/Th2 immune balance in patients.