慢性乙型肝炎患者肾功能早期损害的横断面研究  

Cross-section study of early renal damage in patients with chronic hepatitis B

作　　者：韩雪[1,2] 李菲[2] 宋立文[2] 刘建勇[2] 宓余强[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市第二人民医院,天津市肝病医学研究所

出　　处：《天津医药》2015年第4期375-378,共4页Tianjin Medical Journal

基　　金：国家十二五科技重大专项基金资助项目(2012ZX10005004)

摘　　要：目的了解慢性乙型肝炎患者的肾功能早期损害情况及其影响因素。方法收集就诊于我院确诊为慢性乙型肝炎且未经系统治疗者的临床资料,并以同期健康体检者为对照,应用简化肾脏病饮食调整工作组(MDRD)方程和慢性肾脏病流行病合作工作组(CKD-EPI)方程计算患者及健康对照者的肾小球滤过率(e GFR)。并对影响e GFR的因素进行分析。结果简化MDRD方程和CKD-EPI方程计算e GFR(M-e GFR、C-e GFR),528例慢性乙型肝炎患者中分别有88例(16.67%)和62例(11.74%)出现e GFR下降,较114例健康对照者中10例(8.77%)和6例(5.26%)的下降率高(χ2分别为4.518和4.156,P<0.05)。多元线性回归分析显示,慢性乙型肝炎患者的年龄、乙肝表面抗原(HBs Ag)和体质指数均是M-e GFR的影响因素;年龄、HBs Ag、性别和血清白蛋白(Alb)水平是C-e GFR的影响因素;而患者的乙肝病毒载量(HBV-DNA)及乙肝e抗原(HBe Ag)均不是M-e GFR或C-e GFR的影响因素。结论慢性乙型肝炎患者可并发一定程度的肾功能早期损害,年龄和HBs Ag水平是主要影响其肾功能的因素,临床上应注意对慢性乙型肝炎患者的肾功能进行监测。Objective To investigate early renal damage of chronic hepatitis B （CHB） patients and the risk factors related to their renal function. Methods CHB patients who visited the second people’s hospital but did not receive systemic treatment were enrolled in our study. Those who visited for general check-up with no hepatic findings during the same period were selected as control group. Glomerular filtration rate （GFR） of all the participants were estimated by simplified MDRD equation and CKD-EPI equation （designated as M-eGFR and C-eGFR respectively）. Influence factors of eGFR were statistically analyzed. Results In the total 528 cases in CHB group, 88 （16.67%） and 62 （11.74%） suffered declined M-eGFR and C-eGFR respectively. By contrast, 10 （8.77%） and 6 （5.26%） cases in the total 114 cases in control group present declined M-eGFR and C-eGFR ac？cordingly. Percentages of renal function impairment, estimated by both M-eGFR and C-eGFR, were higher in the CHB group than those in control group. The difference was statistically significant （χ2=4.518, P＆lt;0.05;χ2=4.156, P＆lt;0.05）. Multiple linear regression analysis indicated that age, HBsAg and body mass index （BMI） were risk factors of M-eGFR while age, HBsAg, gender and serum albumin were risk factors of C-eGFR. On the other hand, HBV-DNA and HBeAg were not risk factors for M-eGFR or C-eGFR. Conclusion HBV infection can lead to early renal damage. Age and HBsAg are main risk factors of renal function impairment. Therefore, renal function should be scrutinized in CHB patients.

关 键 词：肝炎 乙型 慢性 肾小球滤过率 肝炎表面抗原 乙型 肾功能早期损害 

分 类 号：R512.62[医药卫生—内科学]