长期应用替诺福韦酯治疗对慢性乙型肝炎患者肾功能的影响  

Effects of tenofovir on renal function in long-term treatment of chronic hepatitis B patients

作　　者：李红艺[1] 朱倩钰 任江波[1] 孙淑杰[1] 王辉[1] 杨妙然 姜亦洲 黎寒梅 武珊珊[1] 王宇[1] 马红[1] LI Hong - yi;ZHU Qian - yu;REN Jiang - bo(Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.)

机构地区：[1]首都医科大学附属北京友谊医院肝病中心,北京100050

出　　处：《临床和实验医学杂志》2018年第12期1257-1260,共4页Journal of Clinical and Experimental Medicine

基　　金：国家科技部"艾滋病和病毒性肝炎等重大传染病防治"科技重大专项(编号:2017zx10202202)

摘　　要：目的了解慢性乙型肝炎患者长期服用替诺福韦酯(TDF)治疗后肾功能损害的发生情况,并对导致肾功能异常的影响因素进行分析。方法回顾性分析2011~2017年首都医科大学附属北京友谊医院收治的核苷(酸)类似物(NAs)初治或经治(TDF除外)的43例慢性乙型肝炎患者的病例资料,患者均规律使用TDF单药抗病毒治疗0.5~6.0年且每半年定期随访,观察患者肾小球滤过率(eGFR,CKD-EPI公式计算)、血磷等的变化情况,计算TDF治疗间eGFR及血磷异常率,并对其影响因素行Logistic回归分析。结果本研究共收集43例病例,在治疗0.5~6.0年后,患者每年eGFR均较基线下降,除第1年下降2.78 ml/(min·1.73m^2)(P=0.063)和第3年下降0.65 ml/(min·1.73m^2)(P=0.760)外,其余观察点eGFR较基线显著下降(P<0.05)。患者的血磷值在经TDF治疗后每年较基线无明显变化,且差异均无统计学意义(P>0.05)。在治疗过程中,有25例(58.1%)患者出现肾功能异常,6例(14.0%)患者出现血磷异常。经Logistic回归分析结果显示,年龄和肌酐是肾功能异常的危险因素;基线血磷是治疗期间出现血磷异常的保护性因素。结论长期应用TDF治疗可能导致慢性乙型肝炎患者eGFR下降,对于经治患者、老年患者以及基线时已出现肌酐上升或血磷下降的患者更应注意肾功能指标的监测。Objective To explore the incidence of renal dysfunction in patients with chronic hepatitis B（ CHB） after long-term treatment with tenofovir disoproxil fumarate（ TDF）,and to analyze the influencing factors leading to abnormal renal function. Methods We performed a retrospective analysis of NAs treatment-experienced（ except TDF） and treatment-na？ ve CHB patients between 2011 and 2017 at Beijing Friendship Hospital. They were regularly followed up every six months with TDF monotherapy. The change of glomerular filtration rate（ e GFR,which were calculated by CKD-EPI formula） and blood phosphorus were observed. The abnormal rate of e GFR and blood phosphorus during TDF treatment were calculated,and the influencing factors were analyzed by logistic regression analysis. Results A total of 43 cases were collected in this study. During the period of 0. 5 ~ 6 years of treatment,the e GFR of the observation point was significantly lower than that of the baseline（ P〈0. 05）,except for the decrease of 2. 78 ml/（ min·1. 73 m^2）（ P = 0. 063） in the first year and 0. 65 ml/（ min·1. 73 m^2）（ P = 0. 760）in the third year. There was no significant change in serum phosphorus level after TDF treatment compared with baseline,and the difference was not statistically significant（ P〉0. 05）. During the treatment period,there were 25 cases（ 58. 1%） developed abnormal renal function and 6（ 14. 0%） occurred abnormal serum phosphorus. The results of Logistic regression analysis showed that age and creatinine were considered risk factors for abnormal renal function,and baseline level of serum phosphorus was a protective factor for abnormal serum phosphorus during the treatment. Conclusion Long-term application of TDF may lead to the decrease of e GFR in patients with chronic hepatitis B. For treatment-experienced patients,elderly patients and patients with elevated creatinine level or decreased serum phosphorus at baseline should pay more attention to monitoring renal function.

关 键 词：慢性乙型肝炎 替诺福韦酯 肾功能 

分 类 号：R512.62[医药卫生—内科学]