替比夫定或拉米夫定联合糖皮质激素治疗慢性肾小球肾炎合并慢性HBV感染患者的疗效研究  

Study on effect of telbivudine or lamivudine combined with glucocorticoid in treating patients with chronic glomerulonephritis complicating chronic HBV infection

作　　者：李丽娜 赵洪雯 孙岩 申兵冰 刘宝莲 潘乾广 LI Lina;ZHAO Hongwen;SUN Yan;SHEN Bingbing;LIU Baolian;PAN Ganguang(Department of Nephrology,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Nephrology,Affiliated Southwest Hospital of Army Military Medical University,Chongqing 400038,China)

机构地区：[1]重庆医科大学附属第三医院肾内科,重庆401120 [2]陆军军医大学附属西南医院肾内科,重庆400038

出　　处：《现代医药卫生》2021年第1期65-68,共4页Journal of Modern Medicine & Health

摘　　要：目的探讨替比夫定(LdT)或拉米夫定(LAM)联合糖皮质激素治疗慢性肾小球肾炎(CGN)合并慢性乙型肝炎病毒(HBV)感染患者的疗效。方法选取2011年11月至2015年11月陆军军医大学附属西南医院收治的CGN合并慢性HBV感染患者48例,其中给予LdT治疗28例(LdT组),给予LAM治疗20例(LAM组)。48例患者均同时使用糖皮质激素治疗,随访16个月。比较2种药物抗病毒治疗的安全性及有效性。结果与治疗前比较,LdT组患者治疗后HBV DNA载量明显下降,差异有统计学意义(P<0.05);LAM组患者治疗后HBV DNA载量无明显变化,差异无统计学意义(P>0.05);2组患者治疗后16个月24 h尿蛋白定量、血清清蛋白均明显改善,差异均有统计学意义(P<0.05);2组患者治疗后血清肌酐、肾小球滤过率估计值比较,差异均无统计学意义(P>0.05)。2组患者均未发生肌酸激酶升高、肝功能衰竭等不良反应。结论对于CGN合并慢性HBV感染且需使用糖皮质激素的患者,LdT抗病毒效果优于LAM,且对肾脏功能无明显损害。Objective To investigate the effect of telbivudine(LdT)or lamivudine(LAM)combined with glucocorticoid in the treatment of the patients with chronic glomerulonephritis(CGN)complicating chronic HBV infection.Methods Forty-eight patients with CGN complicating chronic HBV infection treated in the Affiliated Southwest Hospital of Army Military Medical University from November 2011 to November 2015 were selected,among them 28 cases were given the LdT treatment(LdT group)and 20 cases were treated by LAM(LAM group).Forty-eight cases all used glucocorticoids at the same time.The cases were followed up for 16 months.Then the safety and effectiveness of antiriral treatment were compared between the two antiviral drugs.Results Compared with that before treatment,the HBV DNA load after treatment in the LdT group was decreased significantly,and the difference was statistically significant(P<0.05),while the HBV DNA load after treatment in the LAM group had no significant change,and the difference was not statistically significant(P>0.05).The 24 h urine protein quantity and serum albumin 16 months after treatment in both LdT group and LAM group were significantly improved,and the difference was statistically signifciant(P<0.05).No statistical difference was observed in the serum Creatinine and estimated glomerular filtration rate after treatment between the LdT group and LAM group(P>0.05).There were no adverse reactions occurrence such as the increase of creatine kinase and liver function failure in both groups.Conclusion In the patients with CGN complicating chronic HBV infection needing glucocorticoid,LdT has a better antiviral effect than LAM,and has no obvious damage to renal function.

关 键 词：慢性病 肾小球肾炎 乙型肝炎病毒 感染 糖皮质激素类 拉米夫定 替比夫定 

分 类 号：R692.31[医药卫生—泌尿科学] R373.2[医药卫生—外科学]