血清中β2微球蛋白、视黄醇结合蛋白、胱抑素C在替诺福韦或恩替卡韦单药治疗慢性乙型肝炎早期肾功能变化中的意义  

Changes in serum β2-microglobulin, retinol-binding protein, and cystatin C and their value in identifying early renal dysfunction in patients with chronic hepatitis B .undergoing tenofovir or entecavir monotherapy： acomparative analysis

作　　者：何佳[1] 宁会彬 曾艳丽[1] 李威[1] 李宽[1] 尚佳[1] 

机构地区：[1]河南省人民医院感染科,郑州450003

出　　处：《中华肝脏病杂志》2016年第9期643-646,共4页Chinese Journal of Hepatology

基　　金：国家临床重点专科建设项目（2013年度）;河南省科技厅研究项目（142300410372）;河南省医学科技攻关计划项目（201203090）

摘　　要：目的比较单用替诺福韦或恩替卡韦抗HBV过程中，慢性乙型肝炎患者血清中β2微球蛋白、视黄醇结合蛋白及胱抑素C的动态变化，探讨三者在发现早期肾功能损害中的意义。方法收集2013年6月至2015年8月初治的慢性乙型肝炎患者资料，分为替诺福韦组、恩替卡韦组。分别比较基线时、抗病毒治疗后4周、8周、39周、52周、78周、104周时两组患者血清中p，微球蛋白、视黄醇结合蛋白、胱抑素C、肌酐、估算肾小球滤过率（eGFR）的变化。计量资料比较用独立样本t检验，计数资料比较采用X^2检验，P〈0．05为差异有统计学意义。结果共纳入61例慢性乙型肝炎患者（替诺福韦组31例，恩替卡韦组30例），两组患者β2微球蛋白、视黄醇结合蛋白、胱抑素C在基线水平均有可比性，在4周、8周、39周、52周、78周、104周，β2微球蛋白、视黄醇结合蛋白的差异均有统计学意义（P值均〈0．05）；胱抑素C比较在78周时差异有统计学意义（t=-2．062，P=0．044），104周时差异无统计学意义（t=-1．544，P=0．128）；血肌酐、eGFR在各时间段上的比较差异均无统计学意义（P值均〉0．05）。104周时两组HBVDNA转阴率、病毒学突破水平差异均无统计学意义（P〉0．05）。结论监测替诺福韦或恩替卡韦在抗HBV的过程中对早期肾功能的损害，血清中β2微球蛋白、视黄醇结合蛋白及胱抑素C较eGFR变化更敏感。Objective To investigate the dynamic changes in serum ~2-microglobulin, retinol- binding protein, and cystatin C in chronic hepatitis B （CHB） patients treated with tenofovir or entecavir alone as the anti-HBV therapy, as well as their value in identifying early renal dysfunction. Methods A total of 61 previously untreated CHB patients who were diagnosed and treated in the Department of Infectious Diseases in Henan Provincial People＇s Hospital from June 2013 to August 2015 were enrolled and divided into tenofovir group and entecavir group. The serum levels of β2-microglobulin, retinol-binding protein, cystatin C, and creatinine and estimated glomerular filtration rate （eGFR） were compared between the two groups at baseline and 4, 8, 39, 52, 78, and 104 weeks after antiviral therapy. The independent samples t-test was used for comparison of continuous data, and the chi-square test was used for comparison of categorical data. P 〈0.05 was considered statistically significant. Results A total of 61 CHB patients were enrolled, with 31 in the tenofovir group and 30 in the entecavir group. The two groups had comparable serum levels of β2-microglobulin, retinol-binding protein, and cystatin C at baseline, but there were significant differences in β2-microglobulin and retinol-binding protein over time （both P 〈 0.05）. There was a significant difference in cystatin C at 78 weeks （t = -2.062, P = 0.044）, but there was no significant difference at 104 weeks （t = -1.544, P = 0.128）. There were no significant differences in serum creatinine or eGFR at any time point between the two groups （P 〉 0.05）. At 104 weeks, there were no significant differences in HBV-DNA clearance rate or the level of virologic breakthrough between the two groups （P 〉 0.05）. Conclusion Serum β2-microglobulin, retinol binding protein, and cystatin C are more sensitive than eGFR in the monitoring of early renal dysfunction during the anti-HBV therapy with tenofovir or entecavir alone.

关 键 词：肝炎 乙型 慢性 视黄醇结合蛋白质类 胱抑素C 

分 类 号：R512.62[医药卫生—内科学]