甲泼尼龙联合恩替卡韦治疗原发性肾病综合征合并乙型肝炎病毒感染的疗效观察  

Efficacy Observation of Methylprednisolone Combined with Entecavir in the Treatment of Primary Nephrotic Syndrome with Hepatitis B Virus Infection

作　　者：裴文燕[1] 

机构地区：[1]新乡市中心医院肾内科,河南新乡453000

出　　处：《中国药房》2016年第6期768-770,共3页China Pharmacy

摘　　要：目的：观察甲泼尼龙联合恩替卡韦治疗原发性肾病综合征合并乙型肝炎病毒感染的疗效和安全性。方法：23例原发性肾病综合征合并乙型肝炎病毒感染患者给予恩替卡韦片0.5 mg,口服,每日1次,连用2周,后加用甲泼尼龙片0.8 mg/（kg·d）,口服,每日1次,连用8周,后以该剂量隔天用药,连用2~3个月,后剂量减少4 mg,隔天用药,连用4周,后每2~4周减量1次,每次减少4 mg,直至停药。恩替卡韦片应用于整个治疗过程中,待甲泼尼龙片停药后3个月内根据乙型肝炎病毒脱氧核糖核酸（HBV-DNA）定量调整剂量并逐渐停药。观察所有患者的肝脏疗效、肾脏疗效,治疗前、治疗后2、6、12、15个月的肾脏24 h尿蛋白定量、血清白蛋白（ALB）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）水平及不良反应发生情况。结果：所有患者的肝脏疗效、肾脏疗效均为100%;治疗2、6、12、15个月后,肾脏24 h尿蛋白定量、ALT、AST均显著低于治疗前,且随时间延长逐渐降低,ALB均显著高于治疗前,且随时间延长逐渐升高,差异均有统计学意义（P〈0.05）;不良反应发生率为43.48%,所有患者均未见严重不良反应发生,且均未出现肝肾功能损害。结论 ：甲泼尼龙联合恩替卡韦治疗原发性肾病综合征合并乙型肝炎病毒感染疗效显著,安全性较好。OBJECTIVE：To observe the efficacy and safety of methylprednisolone combined with entecavir in the treatment of primary nephrotic syndrome with hepatitis B virus infection. METHODS：23 primary nephrotic syndrome patients with hepatitis B virus infection were given 0.5 mg/times Entecavir tablet,orally,once a day,for 2 weeks,and added 0.8mg/（kg.d）Methylprednisolone tablet,orally,once a day,for 8 weeks,then the dose was maintained for 2-3 months every other day,and then decreased 4mg for 4 weeks every other day,and the dose was decreased 4 mg every 2-4 weeks,until drug withdrawal. Entecavir tablet was used in the whole process of Methylprednisolone tablet,the dose was adjusted and gradually stopped based on HBV-DNA within 3months of Entecavir tablet withdrawal. Liver and renal efficacy,24 h urine protein excretion,serum albumin（ALB）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）levels before and after treatment of 2,6,12 and 15 months,and the incidence of adverse reactions of all patients were observed. RESULTS：The liver and renal efficacy were 100%;after treatment of 2,6,12 and 15 months,24 h urine protein,ALT and AST were significantly lower than before and gradually decreased by time,ALB was significantly higher than before and gradually increased by time,the differences were statistically significant（P〈0.05）;the incidence of adverse reactions was 43.48%,and there were no obvious adverse reactions and no renal dysfunction. CONCLUSIONS：Methylprednisolone combined with entecavir has significant efficacy in the treatment of primary nephrotic syndrome with hepatitis B virus infection,with good safety.

关 键 词：甲泼尼龙 恩替卡韦 原发性肾病综合征 乙型肝炎病毒感染 

分 类 号：R512.62[医药卫生—内科学]