替比夫定联合阿德福韦酯治疗慢性乙型肝炎患者血清eGFR的动态变化  

Influence of Telbivudine or Adefovir Dipivoxil monotherapy on eGFR of patients with chronic hepatitis B

作　　者：韩峰[1] 周莹[2] Feng Han;Ying Zhou(Department of Infectious Diseases,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110021,China;Department of Infectious Diseases,the First Hospital of China Medical University,Shenyang,Liaoning 110001,China)

机构地区：[1]中国医科大学附属盛京医院感染科,辽宁沈阳110021 [2]中国医科大学附属第一医院传染科,辽宁沈阳110001

出　　处：《中国现代医学杂志》2018年第13期100-103,共4页China Journal of Modern Medicine

摘　　要：目的评价替比夫定(L-DT)联合阿德福韦酯(ADV)单药治疗慢性乙型肝炎(CHB)对肾脏功能的影响,明确L-DT是否具有改善肾小球滤过率的作用。方法回顾性分析应用L-DT及ADV单药治疗的118例CHB患者治疗基线、治疗24和52周时肾小球滤过率(e GFR)的动态变化,比较两组患者中肾功能受损e GFR<90 ml/(min·1.73 m^2)患者的比例。结果治疗52周时与基线相比,替比夫定组CR降低,e GFR升高(P<0.05);阿德福韦酯组CR升高,e GFR降低(P<0.05)。治疗前后均未观察到CR高于正常值上限(ULN)或较基线升高>0.50 mg/dl患者;L-DT组中,以e GFR衡量的肾功能受损患者的构成比,由基线时的20.90%降至52周时的5.97%,而ADV组则由19.61%升至23.53%。两组在基线时比较差异无统计学意义(P>0.05),治疗52周时差异有统计学意义(P<0.05)。结论应用替比夫定抗病毒治疗,能够提高血清e GFR,改善肾脏功能,而应用ADV治疗则需早期警惕血清e GFR的下降,及时进行治疗方案的调整。To investigate the changes in the renal function of the patients with chronic hepatitis B(CHB)receiving Telbivudine(L-DT)or Adefovir(ADV)monotherapy,and determine whether L-DT has the effect of increasing the estimated glomerular filtration rate(eGFR).Methods A retrospective analysis was made for 118 CHB patients receiving either L-DT(n=67)or ADV(n=51)monotherapy for 52 weeks.The dynamic changes of eGFR on baseline,in the 24th and 52nd weeks of treatment were analyzed.The proportions of the patients with impaired renal function(eGFR<90 ml/min?1.73 m2)were compared between both groups.Results Compared to the baseline levels,CR decreased and eGFR increased significantly in the L-DT group after 52 weeks of treatment(P<0.05),while CR increased and eGFR decreased significantly in the ADV group(P<0.05).No patient was found to have CR higher than the upper limit of normal level(ULN)or an elevation of CR over 0.50 mg/dl before and after treatment.In the L-DT group the proportion of the patients with impaired renal function(based on eGFR)decreased from 20.90%at baseline to 5.97%at the 52th week,while that in the ADV group increased from 19.61%to 23.53%.The proportion of the patients with impaired renal function had no statistical difference at baseline(P>0.05),but had statistical difference at week 52(P<0.05)between the two groups.Conclusions L-DT antiviral therapy can increase eGFR and improve the renal function.However,when using ADV therapy,the decrease of serum eGFR should be paid attention in early stage,and the therapy should be adjusted timely.

关 键 词：慢性乙型肝炎 肾功能 肾小球滤过率 替比夫定 阿德福韦酯 

分 类 号：R512.62[医药卫生—内科学]