应用核苷(酸)类治疗慢性乙型肝炎患者早期肾功能的变化  

Early impact of nucleos(t)ide analogs on renal function tests in patients with chronic hepatitis B

作　　者：姜悦萌 马于琪 阚春明[2] 尹华发[1] Jiang Yuemeng;Ma Yuqi;Kan Chunming(Department of Infectious Diseases,First Affiliated Hospital,Anhui Medical University,Hefei 230022,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥市230022 [2]安徽医科大学第一附属医院肾脏内科实验室,合肥市230022 [3]南京市第二医院肝病二科

出　　处：《实用肝脏病杂志》2022年第3期351-354,共4页Journal of Practical Hepatology

基　　金：国家科技重大专项基金资助项目(编号:2018ZX10302-206)。

摘　　要：目的研究应用一线核苷(酸)类(NAs)治疗慢性乙型肝炎(CHB)患者早期对肾功能的影响。方法2019年9月~2021年5月安徽医科大学第一附属医院感染病科门诊诊治的CHB患者68例,其中应用ETV治疗22例,TDF治疗26例,TAF治疗20例,随访观察6 m。检测血肌酐(sCr),计算估算的肾小球滤过率(eGFR),检测尿视黄醇结合蛋白(RBP)、尿胱抑素C(Cys-C)、尿N.乙酰.β.D.葡萄糖苷酶(NAG)、尿α1微球蛋白(α1-MG)和尿β2微球蛋白(β2-MG)。结果在治疗24±2 w后,ETV治疗组、TDF治疗组和TAF治疗组血清ALT水平分别为(33.2±5.4)U/L、(31.4±8.2)U/L和(32.7±6.1)U/L,差异无统计学意义(P>0.05),三组血清AST水平分别为(23.8±7.6)U/L、(24.3±9.2)U/L和(22.9±7.8)U/L,差异无统计学意义(P>0.05);三组血清HBsAg水平分别为(3.0±0.7)lgIU/mL、(2.9±0.5)lgIU/mL和(2.8±0.6)lgIU/mL,血清HBV DNA载量分别为(1.9±0.6)lgIU/mL、(1.8±0.5)lgIU/mL和(1.6±0.7)lgIU/mL,差异均无统计学意义(P>0.05);三组sCr、eGFR、尿RBP、尿Cys-C、尿NAG和尿β2-MG变化均无统计学差异(P>0.05),而TDF治疗组尿α1-MG水平为(1.4±0.9)lnmg/L,显著高于另外两组【分别为(0.7±1.1)lnmg/L和(0.7±0.9)lnmg/L,P<0.05】。结论本研究结果提示,尽管应用ETV、TDF和TAF治疗CHB患者的疗效相近,但应用TDF治疗可能对肾功能有一定的影响,应注意检测。Objective The aim of this study was to observe the early impact of first-line nucleos(t)ide analogs(NAs),e.g.entecavir(ETV),tenofovir disoproxil fumarate(TDF)and tenofovir alafenamide(TAF),on renal function tests in patients with chronic hepatitis B(CHB).Methods 68 patients with CHB were encountered in our Hospital between September 2019 and May 2021,and out of them,22 patients received ETV,26 patients received TDF and 20 patients took TAF therapy.All the patients were followed-up for six months.Serum creatinine(sCr),estimated glomerular filtration rate(eGFR),urine retinol-binding protein(RBP),urine cystatin C(Cys-C),urine N.acetyl.β.D.glucosidase(NAG),urineα1-microglobulin(α1-MG)and urineβ2-microglobulin(β2-MG)levels were observed.Results At the end of 24±2 weeks of treatment,serum alanine aminotransferase levels in ETV-treated,TDF-treated and TAF-treated patients were(33.2±5.4)U/L,(31.4±8.2)U/L and(32.7±6.1)U/L(P>0.05),and serum aspartate aminotransferase levels in the three groups were(23.8±7.6)U/L,(24.3±9.2)U/L and(22.9±7.8)U/L,not significantly different among them(P>0.05);serum HBsAg levels in the three groups were(3.0±0.7)lgIU/ml,(2.9±0.5)lgIU/ml and(2.8±0.6)lgIU/ml,and serum HBV DNA loads in the three groups were(1.9±0.6)lgIU/mL,(1.8±0.5)lgIU/mL and(1.6±0.7)lgIU/mL,not significantly different among them(P>0.05);there were no statistically significantly differences as respect to sCr,eGFR,urinary RBP,urinary Cys-C,urinary NAG and urinary β2-MG levels in the three groups(P>0.05),while urineα1-MG level in TDF-treated patients was(1.4±0.9)ln mg/L,significantly higher than(0.7±1.1)ln mg/L in ETV-treated or(0.7±0.9)ln mg/L in TAF-treated patients(P<0.05).Conclusion Our findings suggests that ETV,TDF and TAF have the same antiviral efficacy in patients with CHB,but the renal function tests should be specially surveyed in patients with TDF treatment.

关 键 词：慢性乙型肝炎 替诺福韦酯 丙酚替诺福韦 尿Α1微球蛋白 安全性 

分 类 号：R512.62[医药卫生—内科学]