替比夫定预防肝移植后乙型肝炎复发并保护肾功能的17例临床观察  

Telbivudine prevents hepatitis B virus recurrence and improves renal function after liver transplantation in clinical observation of 17 cases

作　　者：刘现忠[1] 张冬华[1] 李增才[1] 王轩[1] 张斌[1] 江涛[1] 陆雷[1] 王兵济[1] 张荣生[1] 

机构地区：[1]南京中医药大学附属八一医院 南京军区肝脏移植中心,210002

出　　处：《中华器官移植杂志》2016年第11期658-662,共5页Chinese Journal of Organ Transplantation

基　　金：南京军区科技创新课题基金（14ZX07）

摘　　要：目的探讨替比夫定预防乙型肝炎肝硬化肝移植术后乙型肝炎复发，并改善肾功能不全的作用及中远期疗效观察。方法前瞻性研究17例乙型肝炎肝硬化肝移植术后伴有肾功能不全的受者。17例受者中12例采用以他克莫司为主的免疫抑制方案，5例采用以西罗莫司为主的免疫抑制方案。17例受者中，入组前3例服用拉米夫定＋阿德福韦酯，4例服用替诺福韦酯，10例服用恩替卡韦，入组后均改为服用替比夫定。研究期间，监测乙型肝炎病毒（HBV）DNA值。统计受者入组前6个月及人组时基础血清肌酐值和估算肾小球滤过率（eGFR）值（CKD-EPI公式评估），分别于用替比夫定后第6个月和12个月时统计血清肌酐值、eGFR值，同时观察用药后受者一般状况及不良反应。结果17例受者平均随访时间为20．2个月，随访过程中死亡1例，另16例于用药前6个月、入组时及用药后6、12个月时检测的血清肌酐值分别为（105．74±18．24）、（112．26±18．67）、（96．48±22．01）和（89．17±19．56）μmol／L。eGFR值分别为（72．56±14．39）、（66．23±16．61）、（79．77±20．15）和（83．93±23．67）ml·min^-1·m^-2，与入组时基础测定值相比，替比夫定用药后6、12个月时血清肌酐值和eGFR值均得到明显改善（P〈0．05），在入组前6个月、入组时、用药后6个月及12个月时eGFR值≤60μmol／L的受者所占比例分别为25％、37．5％、12．5％和6．3％。1例受者因血清肌酸激酶升高（为1023IU／L），于研究结束后3个月将替比夫定改为替诺福韦酯，停用替比夫定后肌酸激酶水平下降。研究中未观察到乙型肝炎复发及排斥反应发生的受者。结论HBV肝硬化受者行肝移植术后并发肾功能不全，应用替比夫定可有效改善肾功能，同时预防HBV复发，但还有待大样本长期临床研究数据进一步证实。Objective To approach the effect of telbivudine for preventing recurrence of virus and improving renal function in patients with hepatitis B cirrhosis after liver transplantation with renal insufficiency, and observe the mid- and long-term efficacy. Methods We prospectively researched 17 cases of hepatitis B cirrhosis after liver transplantation with renal insufficiency. Maintenance immunosuppression protocol at our centre mainly included calcineurin inhibitor （tacrolimus for 12 cases,and sirolimus for 5 cases）. These recipients （n = 17） remained under the entecavir （n = 10）, tenofovir （n = 4）, lamivudine ＋ adefovir （n = 3） for at least 6 months before transformation to telbivudine. We detected HBV DNA level in serum and ensured no rejection during study, necessarily punctured the graft liver for biopsy to determine if there was rejection. The basal values of blood serum creatinine （Scr） and estimated glomerular filtration rate （eGFR, CKD-EPI formula） were recorded. The Scr and eGFR at 6th month before research and basal values and at 6th and 12th month after telbivudine administration were detected,at the same time the general state and adverse reactions were evaluated. Results During the average follow-up period of 20. 2 months, 1 patients died. The Scr levels detected in the rest 16 patients were 105.74± 18. 24,112. 26 ±18. 67,96. 48 ± 22. 0 and 89. 17 ±19. 56 μmol/L respectively at 6th month before, basal time and 6th, 12th month after telbivudine administration. The eGFR values were 72. 56 ± 14. 39, 66. 23 ±16. 61,79. 77 ±20. 15 and 83.93 ± 23. 67 mL/（minute· m^2） at different time points respectively. As compared with the basal value, the Scr and eGFR levels were improved obviously （P〈0. 05） at 6th and 12th month after telbivudine administration. The proportion of patients with eGFR 〈60 mL/（min·m^2） in 16 cases was 25%, 37. 5%,12. 5% and 6. 3% respectively at 6th month before, basal time and 6th, 12th month after telbivudine administration. The serum

关 键 词：乙型肝炎病毒 肝移植 肾功能不全 替比夫定 

分 类 号：R657[医药卫生—外科学] R51[医药卫生—临床医学]