核苷(酸)类似物抗病毒治疗乙型肝炎病毒相关性肾炎疗效观察  

Therapeutic efficacy of lamivudine or entecavir treatment on patients with hepatitis B virus-associated glomerulonephritis

作　　者：孟繁平[1] 龚清[1] 韩军[1] 金波[1] 马雪梅[1] 申力军[1] 吴贻琛[1] 吴勤[1] 李捍卫[1] 

机构地区：[1]解放军第三○二医院肝硬化诊疗中心,北京100039

出　　处：《传染病信息》2010年第4期206-208,共3页Infectious Disease Information

基　　金：国家自然科学基金青年基金(30901795)

摘　　要：目的评价核苷(酸)类似物治疗乙型肝炎(乙肝)病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)合并慢性乙肝或肝硬化的临床疗效和安全性。方法选择病理诊断为HBV-GN,同时合并慢性乙肝或肝硬化的患者共36例。患者分成2组:核苷(酸)类似物抗病毒治疗组25例,给予拉米夫定0.1g,1次/d,或恩替卡韦0.5mg,1次/d,空腹口服;对照组11例,未给予核苷(酸)类似物抗病毒治疗。2组均给予常规保肝降酶及保护肾功能的治疗。观察治疗前后临床指标变化,包括用药期间尿蛋白排泄情况、肝肾功能和乙肝病毒学指标以及不良反应。结果治疗12个月时,抗病毒治疗组24h尿蛋白定量较治疗前明显减少,血清ALB较治疗前明显升高;对照组24h尿蛋白定量和ALB与治疗前相比无显著改善。2组ALT和AST水平治疗后均明显改善,但抗病毒治疗组ALT和AST下降幅度明显大于对照组。抗病毒治疗组血清HBV DNA水平治疗后明显下降,对照组治疗前后无明显变化。抗病毒治疗组治疗12个月时的完全缓解率、总有效率明显高于对照组。结论核苷(酸)类似物治疗HBV-GN,可显著降低尿蛋白,使ALB升高,HBV DNA水平降低,缓解肾病综合征的临床症状,取得满意疗效,且耐受性好,未见明显不良反应。Objective To evaluate the efficacy and safety of lamivudine or entecavir treatment on patients with hepatitis B virus-associated glomerulonephritis （HBV-GN）. Methods Totally 36 HBV-GN patients combined with chronic hepatitis B or liver cirrhosis were divided into 2 groups, with 25 patients in nucleos（t）ide analogue antiviral therapy group and 11 in control group. The antiviral therapy group received oral lamivudine 0.1 g or entecavir 0.5 mg once daily. The control group wasn＇t given antiviral therapy. Both the groups were given regular treatment for liver protection, enzyme reduction and the protection of renal function. Clinical markers including urinary protein, biochemical markers of liver and renal function and HBV serum markers and adverse reactions before and after treatment were observed. Results After 12 months of treatment, significant decrease in urinary protein and increase in serum albumin （ALB） were observed in antiviral therapy group, while no significant differences were found in urinary protein and serum ALB in the control group. ALT and AST levels decreased in both groups, but ALT and AST levels of the patients in antiviral therapy group decreased more significantly than those of the patients in the control group. Significant decrease in serum HBV DNA levels was observed in antiviral therapy group after treatment, while no significant difference in HBV DNA levels was found in the control group. Complete remission rate and total effective rate in the antiviral therapy group were higher than those in the control group. Conclusions Antiviral therapy with lamivudine or entecavir for HBV-GN achieves good efficacy in the significant decrease in urinary protein and HBV DNA levels, the increase in ALB levels and the relief of nephritic syndrome. Moreover, the patients have good tolerance of the antiviral therapy and no obvious adverse reactions are found.

关 键 词：肝炎病毒 乙型 肾小球肾炎 抗病毒药 

分 类 号：R512.62[医药卫生—内科学]