长期应用阿德福韦酯治疗的慢性乙型肝炎患者的尿磷排泄指数变化对肾脏损害预测的相关性研究  

Correlation between changes of urinary phosphorus excretion index and prediction of renal damage in patients with chronic hepatitis B treated with adefovir dipivoxil

作　　者：赵庆锋 肖招英 张东萍[2] 徐孟秋 楼炯波 邵燕[2] 丁秋明 ZHAO Qingfeng;XIAO Zhaoying;ZHANG Dongping;XU Mengqiu;LOU Jiongbo;SHAO Yan;DING Qiuming(Department of Infectious Diseases,Shengzhou People's Hospital,Zhejiang University First Hospital Shengzhou Branch,Shengzhou 312400,China;Department of Pharmacy,Shengzhou People's Hospital,Zhejiang University First Hospital Shengzhou Branch,Shengzhou 312400,China;Department of Clinical Laboratory,Shengzhou People's Hospital,Zhejiang University First Hospital Shengzhou Branch,Shengzhou 312400,China)

机构地区：[1]浙江省嵊州市人民医院浙大一院嵊州分院感染科,浙江嵊州312400 [2]浙江省嵊州市人民医院浙大一院嵊州分院药剂科,浙江嵊州312400 [3]浙江省嵊州市人民医院浙大一院嵊州分院检验科,浙江嵊州312400

出　　处：《中国现代医生》2019年第12期24-27,I0002,共5页China Modern Doctor

基　　金：浙江省嵊州市科技计划项目(2015-027)

摘　　要：目的探讨长期应用阿德福韦酯(ADV)治疗的慢性乙型肝炎(HBV)患者尿磷排泄指数(FEPO4)变化对早期肾损害预测的相关性。方法收集2006年7月~2018年6月在我院诊治并于36个月后随访的150例CHB患者,平均随访时间7.7年。根据用药时间,分别于治疗第3~6年、6~9年、9~12年设为观察组A(治疗第3~6年)、观察组B(治疗第6~9年)、观察组C(治疗第9~12年)。比较各组FEPO4与eGFR的变化情况。结果治疗后,各观察组eGFR值均未显示异常(均>90mL/min),其中观察组A、观察组C与观察组B比较,差异均有统计学意义(P<0.05);各观察组FEPO4值均>5%,其中观察组A、观察组C与观察组B比较,差异均有统计学意义(P<0.05)。根据FEPO4、eGFR的ROC曲线分析显示,曲线下面积(AUC)分别为0.762、0.704,以检测的灵敏度与特异度之和最大值所对应的值为截定点,得到FEPO4的最佳临界点为5.69%,灵敏度为88.90%,特异度为57.10%;eGFR的最佳临界点为107.50mL/min,灵敏度为61.90%,特异度为19.40%。结论本研究对于用药时间是否是早期肾损害的危险因素未得出定论,还有待进一步研究。FEPO4的灵敏度与特异度均高于eGFR,可见FEPO4可更灵敏地反映ADV的早期肾损害。通过本研究,认为对长期服用ADV治疗的HBV患者,加强检测FEPO4指标对早期评估肾损害、及时干预具有一定的意义。鉴于本研究样本量不大,其临床可行性尚需进一步大样本的研究。Objective To investigate the correlation between the changes of urinary phosphorus excretion index (FEPO4) and early renal damage prediction in patients with chronic hepatitis B (HBV) treated with adefovir dipivoxil (ADV) for long term. Methods A total of 150 patients with CHB who were admitted in our hospital from July 2006 to June 2018 and followed up after 36 months were enrolled. The average follow-up time was 7.7 years. According to the time of administration, the patients with treatment 3-6 years, 6-9 years and 9-12 years were set as observation group A, observation group B and observation group C, respectively. The changes of FEPO4 and eGFR in each group were compared. Results After treatment, the eGFR values were not abnormal in all observation groups(both >90 mL/min), and the difference between the observation group A, the observation group C and the observation group B was significant (P<0.05). FEPO4 value All the observation groups were >5%, and the difference between the observation group A, the observation group C and observation group B was significant (P<0.05). According to the ROC curve analysis of FEPO4 and eGFR, the area under the curve (AUC) was 0.762 and 0.704, respectively. The value corresponding to the maximum value of the sum of sensitivity and specificity of the detection was the cutoff point, and the optimal critical point of FEPO4 was 5.69%, the sensitivity was 88.90%, the specificity was 57.10%. The optimal critical point of eGFR was 107.50 ml/min, the sensitivity was 61.90%, and the specificity was 19.40%. Conclusion This study has not been conclusive about whether the time of administration is a risk factor for early renal damage, and further research is needed. The sensitivity and specificity of FEPO4 are higher than that of eGFR. It can be seen that FEPO4 can reflect the early renal damage of ADV more sensitively. Through this study, we believe that in HBV patients with long-term use of ADV treatment, strengthening the detection of FEPO4 indicators to early assessment of renal dama

关 键 词：慢性乙型肝炎 阿德福韦酯 尿磷排泄指数 肾功能损害 

分 类 号：R512.62[医药卫生—内科学] R692[医药卫生—临床医学]