奈玛特韦/利托那韦对肾功能不全新型冠状病毒感染患者肾功能影响的临床观察  

Clinical observation of the effect of nirmatrelvir/ritonavir on renal function in patients with coronavirus disease 2019 and renal insufficiency

作　　者：彭金娥 刘慧 夏见英 王硕 战寒秋 Peng Jin′e;Liu Hui;Xia Jianying;Wang Shuo;Zhan Hanqiu(Department of Pharmacy,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Pharmacy,the First People′s Hospital of Longquanyi District of Chengdu,West China Longquan Hospital Sichuan University,Sichuan Province,Chengdu 610100,China)

机构地区：[1]首都医科大学附属北京地坛医院药学部,北京100015 [2]成都市龙泉驿区第一人民医院(四川大学华西医院龙泉医院)药剂科,成都610100

出　　处：《药物不良反应杂志》2024年第5期275-279,共5页Adverse Drug Reactions Journal

摘　　要：目的探讨奈玛特韦/利托那韦(Paxlovid)对肾功能不全新型冠状病毒感染(COVID-19)患者肾功能的影响。方法收集2022年3月23日至2023年4月30日在首都医科大学附属北京地坛医院住院且应用Paxlovid治疗的肾功能不全COVID-19患者临床资料,对Paxlovid相关急性肾损伤(AKI)的发生情况和Paxlovid治疗前后血尿素、血清肌酐(Scr)、血尿酸和估算肾小球滤过率(eGFR)的变化进行回顾性分析。结果共有386例患者纳入分析,男性220例(57.0%),女性166例(43.0%);中位年龄79岁;COVID-19分型为无症状感染者42例(10.9%),轻型175例(45.4%),普通型126例(32.6%),重型34例(8.8%),危重型9例(2.3%);轻度肾功能不全246例(63.7%),中度肾功能不全110例(28.5%),重度肾功能不全30例(7.8%)。386例患者中16例(4.1%)在Paxlovid治疗期间至停药后48-h内发生AKI,其中5例(1.3%)被判定与Paxlovid相关,均为≥70岁老年人且并用了肾毒性药物。386例患者Paxlovid治疗后与治疗前比较,Scr[(133.8±9.3)μmol/L比(111.7±6.6)μmol/L]、血尿酸[(335.9±7.1)μmol/L比(291.9±5.8)μmol/L]和eGFR[(63.4±1.1)ml/(min·1.73 m2)比(69.1±1.2)ml/(min·1.73 m2)]均有改善,差异有统计学意义(均P<0.05)。结论Paxlovid治疗肾功能不全的COVID-19患者总体安全性好,对绝大多数患者的肾功能无明显影响。但对于≥70岁老年人,尤其并用肾毒性药物的患者仍应警惕AKI的发生。Objective To explore the effect of nirmatrelvir/ritonavir(Paxlovid)on renal function in patients with coronavirus disease 2019(COVID-19)and renal insufficiency.Methods Clinical data of renal insufficiency patients with COVID-19,who were hospitalized at Beijing Ditan Hospital,Capital Medical University from March 23,2022 to April 30,2023 and received Paxlovid treatment,were collected.A retrospective analysis was conducted on the incidence of Paxlovid-related acute kidney injury(AKI)and changes of blood urea,serum creatinine(Scr),blood uric acid,and estimated glomerular filtration rate(eGFR)in patients before and after Paxlovid treatment.Results A total of 386 patients were included in the analysis,including 220 males(57.0%)and 166 females(43.0%),with a median age of 79 years.COVID-19 was classified as asymptomatic in 42 patients(10.9%),mild in 175 patients(45.4%),moderate in 126 patients(32.6%),severe in 34 patients(8.8%),and critical in 9 patients(2.3%).The renal insufficiency was mild in 246 patients(63.7%),moderate in 110 patients(28.5%),and severe in 30 patients(7.8%).Among 386 patients,16(4.1%)developed AKI during Paxlovid treatment or within 48-hours after withdrawal,5(1.3%)of which were judged to be related to Paxlovid.The 5 patients aged 70 years and above,and all used nephrotoxic drugs.After Paxlovid treatment,the blood urea,Scr,blood uric acid,and eGFR in the 386 patients were all improved compared to before,and the differences were statistically significant[Scr:(133.8±9.3)μmol/L vs.(111.7±6.6)μmol/L;blood uric acid:(335.9±7.1)μmol/L vs.(291.9±5.8)μmol/L;eGFR:(63.4±1.1)ml/(min·1.73 m2)vs.(69.1±1.2)ml/(min·1.73 m2);all P<0.05].Conclusions The overall safety of Paxlovid treatment for COVID-19 in patients with renal insufficiency is good,and it has no significant impact on the renal function in the vast majority of patients.However,for elderly people aged 70 years and above,especially for those who have combination medications of nephrotoxic drugs,the occurrence of AKI should still be vigilant.

关 键 词：新型冠状病毒感染 肾功能不全 利托那韦 奈玛特韦 安全性 

分 类 号：R692[医药卫生—泌尿科学] R511[医药卫生—外科学]