恩替卡韦联合糖皮质激素治疗乙肝病毒相关性肾炎的临床观察  

Therapeutic efficacy of entecavir combined with sugar corticosteroid for patients with hepatitis B virusassociated glomerulonephritis

作　　者：任星峰[1] 陈燕[1] 彭隽[1] 杨成[1] 邵紫韫[1] 兰天飙[1] 

机构地区：[1]广州军区武汉总医院肾脏病科,武汉430070

出　　处：《临床肾脏病杂志》2013年第3期110-113,共4页Journal Of Clinical Nephrology

摘　　要：目的观察恩替卡韦联合糖皮质激素治疗乙型肝炎（乙肝）病毒相关性肾炎的临床效果。方法选取在我院住院的乙肝病毒相关性肾炎患者65例，将患者随机分成2组。单一抗病毒组30例，单用恩替卡韦抗病毒治疗。联合治疗组35例，恩替卡韦抗病毒联合适量、短期糖皮质激素治疗。2组均给予常规护肝、降酶及保护肾功能治疗。对所有患者治疗前、后乙肝病毒DNA、肝功能、肾功能、血尿常规进行测定。结果在抗病毒、护肝方面，治疗12个月后，2组血清乙肝病毒DNA载量及丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平下降幅度均无明显差异。但较之单一治疗组，联合治疗组治疗3～6个月时乙肝病毒DNA载量下降延迟，治疗12个月后乙肝病毒e抗原／e抗体血清学转换率降低。在降尿蛋白、护肾方面，较之单一治疗组，治疗3～6个月时，联合治疗组24h尿蛋白定量减少及血清白蛋白升高幅度均有明显优势。治疗12个月后，总有效率显著提高。结论较之单用恩替卡韦抗病毒治疗，恩替卡韦联合适量、短期糖皮质激素治疗可显著降低乙肝病毒相关性肾炎患者的尿蛋白，升高血清白蛋白，提高总有效率，且对恩替卡韦抑制乙肝病毒复制的效果及由此产生的护肝作用无明显影响。Objective To observe the efficacy and safety of entecavir combined with sugar corticosteroid for patients with hepatitis B vires-associated glomerulonephritis（HBV-GN）. Methods Totally 65 HBVGN patients were divided into 2 groups randomly, with 30 patients in single antiviral therapy group and 35 in combined therapy group. The single antiviral therapy group received entecavir oral 0. 5 mg once daily. The combined treatment received enteeavir combined with sugar corticosteroid treatment. 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 For antiviral and liver protection,no significant difference was observed in serum HBV-DNA content and ALT, AST levels between the two groups after 12 months of treatment, while the decrease in HBV-DNA content was significantly delayed during the treatment period of 3～6 months and HBeAg/HBeAb transfer ratio significantly decreased after 12 months of treatment in the combined therapy group as compared with single antiviral therapy group. For protection of renal function, significant decrease in urinary protein excretion and increase in serum albumin（Alb） were observed in the combined therapy group after treatment for 3～6 months. Total effective rate in the combined therapy group was higher than in the single antiviral therapy group after 12 months of treatment. Conclusions The combined treatment with entecavir and sugar corticosteroid for HBV-GN achieves satisfactory efficacy in the significant decrease in urinary protein excretion, the increase in Alb level and total effective rate Moreover, the patients have no obvious adverse reactions in the treatment of antiviral and liver protection.

关 键 词：病毒 治疗 抗原 

分 类 号：R692.3[医药卫生—泌尿科学]