替比夫定治疗对慢性乙型肝炎患者肾小球滤过率的影响及相关因素分析  

Effects and related factors of telbivudine therapy on glomerular filtration rate in patients with chronic hepatitis B

作　　者：欧蔚妮[1] 赵莹莹[1] 魏丽荣[1] 王笑梅[1] 段英[1] 程丹颖[1] 杨松[1] 李贲[1] 邢卉春[1] 成军[1] 

机构地区：[1]首都医科大学附属北京地坛医院肝病中心内五科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第6期55-58,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：十二五国家科技重大专项(No.2012ZX10002003005009);国家科技重大专项课题(No.2012ZX10002003005009)

摘　　要：目的探讨替比夫定在慢性乙型肝炎患者抗病毒治疗期间对肾小球滤过率的影响并分析其可能的相关因素。方法回顾性分析2008年10月至2011年12月在首都医科大学附属北京地坛医院肝病中心就诊并应用替比夫定(600 mg/d)治疗的慢性乙型肝炎患者58例,治疗52周过程中肾小球滤过率的动态变化,并分析其与慢性乙型肝炎(CHB)、ALT及e抗原消失或e抗原血清学转换率动态变化的相关性。肾小球滤过率采用国际公认的肾脏病膳食改良试验(MDRD)公式来计算[肾小球滤过率估计值(eGFR)=186×血清肌酐水平–1.154×年龄–0.203×1.21(黑人)]×[0.742(女性)]。结果治疗52周后患者血肌酐(SCr)下降值与基线比较及eGFR的上升值和基线比差异具有统计学意义。基线时eGFR低于90 ml/min/1.73m2的3例患者的eGFR上升幅度最大(平均eGFR达21.79 ml/min/1.73m2)。进一步用多元线性回归分析发现eGFR的改善与SCr变化相关,与HBV DNA是否低于检测下限、ALT变化、AST变化、肌酸激酶(CK)及HBeAg血清学转换无关。结论用替比夫定治疗慢性乙型肝炎可出现eGFR的升高,且该效应独立于替比夫定的抗病毒作用及相关的ALT复常。Objective To investigate the effects of telbivudine treatment on the estimation of glomerular filtrate rate （eGRR） in patients with chronic hepatitis B （CHB）, and analyze the correlated factors of these effects. Methods Total of 58 CHB patients, treated with LdT in our clinics between October 2008 and December 2011 were analyzed, retrospectively. All the patients received telbivudine 600 mg/d for 52 weeks. Changing valves of eGFR were calculated by the modification of diet in renal disease （MDRD） formula, relevance analysis of eGFR changes HBV DNA levels, ALT and HBeAg were also analyzed, respectively. Results After 52 weeks of treatment, serum creatinine （SCr） reduced and eGFR increased significantly compared with the baseline values. Maximal increases of eGFR were observed in 3 patients with eGFR less than 90 ml/min/1.73 m2 at baseline. Upon further multivariate linear regression analysis, improvement of eGFR correlated with changes of SCr. No correlation was observed with the rate of undetectable HBV DNA, normalized ALT, HBeAg seroconversion and AST, CK levels changes or HBeAg seroconversion. Conclusions Fifty-two weeks therapy with telbivudine in CHB is associated with increase of eGFR. The effects were independent of viral suppression and ALT normalization.

关 键 词：替比夫定 肝炎 乙型 慢性 肾小球滤过率 血肌酐 

分 类 号：R512.62[医药卫生—内科学]