富马酸丙酚替诺福韦治疗首次失代偿期乙型肝炎肝硬化患者的效果和安全性分析  

Efficacy and safety of tenofovir alafenamide fumarate in patients with first-time hepatitis B virus-related decompensated cirrhosis

作　　者：荣欣欣 徐缘媛 杨广德 王霞 傅涓涓 李丽 潘修成 RONG Xinxin;XU Yuanyuan;YANG Guangde;WANG Xia;FU Juanjuan;LI Li;PAN Xiucheng(Department of Infectious Diseases,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院感染性疾病科,江苏徐州221000

出　　处：《临床肝胆病杂志》2024年第10期2008-2013,共6页Journal of Clinical Hepatology

基　　金：国家科技重大专项(2018ZX10302206-001-003)。

摘　　要：目的探讨富马酸丙酚替诺福韦(TAF)在首次失代偿期乙型肝炎肝硬化患者中的应用价值,明确其对肾功能和脂代谢的影响。方法选取2020年1月1日—2022年12月31日在徐州医科大学附属医院接受TAF抗病毒治疗的首次失代偿期乙型肝炎肝硬化住院患者57例,所有患者接受TAF抗病毒治疗。收集患者基线、治疗12、24和48周时病毒学、血清学、肝功能、肾功能、血清磷及血脂等指标。符合正态分布的计量资料组间比较采用配对t检验或单组重复测量方差分析,符合偏态分布的计量资料组间比较采用Friedman检验;计数资料采用χ^(2)检验或Fisher确切概率法。结果共52例患者完成了48周随访。治疗12、24、48周后,实现HBV DNA阴转的比例分别为38.5%、63.5%、84.6%,ALT复常率分别为71.2%、82.7%、82.7%,Child-Pugh A级患者占比分别升至55.8%、73.1%、92.3%。治疗48周内,胱抑素-C(χ^(2)=35.163,P<0.001)、血清磷水平(F=8.600,P<0.001)显著升高。血脂分析中LDL-C水平显著升高(χ^(2)=10.064,P=0.018),TC/HDL-C比值从基线3.61(2.61~5.84)持续下降至3.27(2.70~4.36)(χ^(2)=5.000,P=0.172)。结论TAF可以快速抑制失代偿期乙型肝炎肝硬化患者HBV复制和显著改善肝功能,对肾功能无明显影响,但需密切监测血脂水平。Objective To investigate the application value of tenofovir alafenamide fumarate(TAF)in patients with first-time hepatitis B virus-related decompensated cirrhosis(HBV-DC)and its impact on renal function and lipid metabolism.Methods A total of 57 patients with first-time HBV-DC who were hospitalized and received TAF antiviral therapy in The Affiliated Hospital of Xuzhou Medical University from January 1,2020 to December 31,2022 were enrolled,and all of them received TAF antiviral therapy.Related data were collected at baseline and at weeks 12,24,and 48 of treatment,including virological and serological indicators,liver and renal function,serum phosphorus,and blood lipids.The paired t-test or single group repeated measures ANOVA were used for comparison of normally distributed continuous data,the Friedman test was used for comparison of nonnormally distributed continuous data,and the chi-square test or the Fisher’s exact test were used for categorical data.Results A total of 52 patients completed the 48 weeks of follow-up.After 12,24,and 48 weeks of treatment,the patients achieving HBV DNA seroconversion accounted for 38.5%,63.5%,and 84.6%,respectively;the alanine aminotransferase normalization rate were 71.2%,82.7%,and 82.7%,respectively;the proportion of the patients with Child-Pugh class A disease increased to 55.8%,73.1%,and 92.3%,respectively.Within the 48 weeks of treatment,there were significant increases in the levels of cystatin C(χ^(2)=35.163,P<0.001)and serum phosphorus(F=8.600,P<0.001)and low-density lipoprotein cholesterol(χ^(2)=10.064,P=0.018).The ratio of total cholesterol/high-density lipoprotein cholesterol decreased continuously from 3.61(2.61~5.84)to 3.27(2.70~4.36)(χ^(2)=5.000,P=0.172).Conclusion TAF can rapidly inhibit HBV replication and significantly improve liver function in HBV-DC patients,with no significant impact on renal function.However,blood lipid should be closely monitored.

关 键 词：乙型肝炎 肝硬化 富马酸丙酚替诺福韦 治疗结果 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]