长期服用替诺福韦酯对慢性乙型肝炎患者肾功能的影响  

Effect of long-term tenofovir dipivoxil on renal function in patients with chronic hepatitis B

作　　者：赵雪如 ZHAO Xueru(The Third Department of Liver Disease,Shenyang Sixth People's Hospital,Shenyang,Liaoning,110000,China)

机构地区：[1]沈阳市第六人民医院肝病三科,辽宁沈阳110000

出　　处：《当代医学》2022年第25期126-129,共4页Contemporary Medicine

摘　　要：目的探讨长期服用替诺福韦酯(TDF)对慢性乙型肝炎(CHB)患者肾功能的影响。方法选取2018年8月至2019年12月本院收治的70例CHB患者作为观察组,另选取同期于本院行健康体检的50名健康体检者作为对照组。比较观察组治疗6、12个月后乙肝病毒脱氧核糖核酸(HBV-DNA)不可检测率及两组血清学指标;观察组根据血清学指标检测结果是否异常分为异常组(n=54)和非异常组(n=16),比较异常组与非异常组肾功能指标及血磷水平。结果治疗12个月后,观察组HBV-DNA不可检测率为60.00%,高于治疗6个月后的41.43%,差异有统计学意义(P<0.05)。入院时,两组视黄醇结合蛋白(RBP)、β2微球蛋白(β2-MG)、胱抑素C(Cys-C)、成纤维细胞生长因子-23(FGF-23)水平比较差异无统计学意义;治疗6、12个月后,观察组RBP、β2-MG、Cys-C、FGF-23水平均高于入院时和对照组,差异有统计学意义(P<0.05)。异常组血尿素氮(BUN)水平高于非异常组,肌酐清除率(Ccr)、肾小球滤过率(GFR)、血磷(P)水平均低于非异常组,差异有统计学意义(P<0.05);异常组与非异常组SCr水平比较差异无统计学意义。结论长期服用TDF治疗CHB可取得理想效果,但会导致RBP、β2-MG、Cys-C、FGF-23水平异常升高,增加肾功能损害及低磷性骨病风险,临床需定期监测血清学及肾功能等指标的变化,以及时调整药量,降低用药风险。Objective To investigate the effect of long-term tenofovir dipivoxil(TDF)on renal function in patients with chronic hepatitis B(CHB).Methods 70 patients with CHB admitted to our hospital from August 2018 to December 2019 were selected as the observation group,and 50 healthy people who underwent physical examination in our hospital during the same period were selected as the control group.The undetectable rate of hepatitis B virus deoxyribonucleic acid(HBV-DNA)in the observation group after 6 and 12 months of treatment,and the serological indexes of the two groups were compared;the observation group was divided into abnormal group(n=54)and non-abnormal group(n=16)according to whether the test results of serological index were abnormal or not,the renal function indexes and serum phosphorus levels were compared between the abnormal group and non-abnormal group.Results After 12 months of treatment,the undetectable rate of HBV-DNA in the observation group was 60.00%,which was higher than 41.43%after 6 months of treatment,and the difference was statistically significant(P<0.05).At admission,there was no difference in the levels of retinol-binding protein(RBP)andβ2-microglobulin(β2-MG),Cystatin C(Cys-C)and fibroblast growth factor-23(FGF-23)between the two groups;after 6 and 12 months of treatment,the levels of RBP,β2-MG,Cys-C and FGF-23 were higher than those at the admission and those in the control groups,and the differences were statistically significant(P<0.05).The level of blood urea nitrogen(BUN)in the abnormal group was higher than that in the non-abnormal group,and the levels of creatinine clearance rate(CCR),glomerular filtration rate(GFR)and serum phosphorus(P)were lower than those in the non-abnormal group,and the differences were statistically significant(P<0.05);there was no significant difference in SCr level between abnormal group and non-abnormal group.Conclusion Long term administration of TDF in the treatment of CHB can achieve ideal results,but it will lead to abnormally elevated levels of RBP,β2

关 键 词：慢性乙型肝炎 替诺福韦酯 长期给药 肾功能 

分 类 号：R512.62[医药卫生—内科学]