长期应用核苷(酸)类药物治疗对慢乙肝患者肾功能的影响  

Effects of nucleos (t) ide analogues on renal function in patients with chronic hepatitis B

作　　者：霍娜[1] 陆海英[1] 王贵强[1] 黄明杰[1] 吴赤红[1] 蔺小红[1] HUO Na;LU Haiying;WANG Guiqiang;HUANG Mingjie;WU Chihong;LIN Xiaohong(Department of Infectious Disease, Peking University First Hospital, Beijing 100034, China)

机构地区：[1]北京大学第一医院感染疾病科,北京100034

出　　处：《中国临床药理学与治疗学》2017年第9期1029-1034,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：国家十二五科技重大专项资助项目(2012ZX10002003)

摘　　要：目的:总结长期应用核苷(酸)类药物抗病毒治疗对肾脏功能的影响。方法:记录176例长期应用核苷(酸)类药物抗病毒治疗的慢乙肝患者[阿德福韦酯(ADV)+拉米夫定(LAM)治疗组28例,阿德福韦酯(ADV)+恩替卡韦(ETV)组20例,LAM组21例,ADV组26例,ETV组81例]的临床资料,并计算e GFR。采用KruskalWallis检验、Mann-Whitney检验、χ2检验进行差异性比较分析。结果:ADV+LAM治疗组、ADV+ETV组、LAM组、ADV组、ETV组患者的e GFR分别为:(78.9±13.8)、(80.2±15.8)、(78.8±12.9)、(74.6±14.6)、(79.5±13.1)m L·min-1·1.73 m-2,P>0.05;e GFR<80 m L·min-1·1.73m-2的病例数分别为14(50%)、12(60%)、10(47.6%)、20(69.2%)、47(58.0%),P>0.05;血清磷水平分别为(0.95±0.14)、(0.92±0.11)、(1.02±0.13)、(0.92±0.16)、(0.97±0.14)mmol/L;血清磷降低的病例数分别为15(53.6%)、13(65%)、6(28.6%)、13(50%)、39(48.1%),而且LAM组与ADV+ETV组相比,χ2=5.466 9,P=0.019 4。结论:长期核苷(酸)类药物抗病毒治疗可影响肾脏功能,其中ADV的影响最明显,ETV次之,LAM最轻,而且监测e GFR和血清磷水平能更敏感地反映肾脏受损情况。AIM： To summarize the effects of nucleoside （acid） drugs on renal function in accepting antiviral therapy chronic hepatitis B patients. METHODS： Clinical data of 176 cases of chronic hepatitis B patients treated with nucleoside （acid） antiviral therapy （28 cases in ADV ＋ LAM treatment group, 20 cases in ADV ＋ ETV group, 21 cases in LAM group, 26 cases in ADV group, 81 cases in group ETV ） were recorded, estimated glomerular filtration rate （eGFR） was calculated. The Kruskal- Wallis test or Mann-Whitney test or chi square difference test were used for comparative analysis of differences. RESULTS：The eGFR of the patients in ADV ＋ LAM treatment group, ADV ＋ ETV group, LAM group, ADV group and ETV group were （78.9 ±13.8）, （80.2 ±15.8）, （78.8 ±12.9）, （74.6 ± 14.6）,（79.5 ＋13.1） mL·min^-1·1.73 m^-2, respectively, P 〉 0.05 ; the number of cases with eGFR less than 80 mL·min^-1·1.73 m^-2 were 14 （50%）, 12（60%）, 10（47.6% ）, 20（69.2% ）,47 （58.0%）, respectively, P 〉 0.05. Serum phos- phorus levels were （0.95±0.14） ,（0.92 ±0.11）, （1.02 ±0.13）, （0.92 ± 0.16）, （0.97± 0.14） mmol/L, respectively, P 〉 0.05 ; the number of ca- ses with a decreased serum phosphorus level were 15 （53.6%）, 13（65%）, 6（28.6%）, 13（50%）, 39 （48.1% ） , respectively ; Furthermore, there were statistically significant differences between LAM group and ADV ＋ ETV group （χ^2 = 5. 466 9, P = 0. 019 4 ）. CONCLUSION ： Long-term antiviral therapy of nucleoside （acid） drugs may affect renal function, in which the effect of ADV is the most obvious, ETV is the second, and LAM is the mildest. The monitoring of eGFR and serum phosphorus level is more sensitive to reveal the damage of kidney.

关 键 词：肾小球滤过率估算值(eGFR) 肾损害 拉米夫定 阿德福韦酯 恩替卡韦 

分 类 号：R749[医药卫生—神经病学与精神病学]