恩替卡韦初治慢性乙型肝炎患者发生低磷血症的危险因素  

Risk factors associated with hypophosphatemia in chronic Hepatitis B patients treated with Entecavir of initial therapy

作　　者：王亮[1] 余燕青[2] 邬小萍[1] 马仕鹏 刘丽萍 蔡天盼 李小鹏[1] 葛善飞[1] WANG Liang;YU Yan-qing;WU Xiao-ping;MA Shi-peng;LIU Li-ping;CAI Tian-pan;LI Xiaopeng;GE Shan-fei(Department of Infectious Diseases,the First Affiliated Hospital of Nanchang University,Jiangxi 330000,China;Department of Pathology,the First Affiliated Hospital of Nanchang University,Jiangxi 330000,China;Information Center,the First Affiliated Hospital of Nanchang University,Jiangxi 330000,China)

机构地区：[1]南昌大学第一附属医院感染科,江西330000 [2]南昌大学第一附属医院病理科,江西330000 [3]南昌大学第一附属医院信息处,江西330000

出　　处：《肝脏》2025年第1期78-82,共5页Chinese Hepatology

基　　金：江西省卫生健康委科技计划(202310304)。

摘　　要：目的探讨恩替卡韦(ETV)初治慢性乙型肝炎(CHB)患者发生低磷血症的危险因素及动态变化。方法选取2020年1月至2023年6月于南昌大学第一附属医院感染科接受ETV治疗的CHB患者148例。采用Cox回归风险模型分析CHB患者发生低磷血症的危险因素,运用受试者工作特征曲线下面积(AUC)评估CHB患者发生低磷血症的效能。采用Kaplan-Meier分析低磷血症累积发生率,并应用Log-rank检验进行比较。相关性采用Spearman Correlation进行分析。动态观察治疗期间血磷和eGFR变化。结果148例患者中发生低磷血症17例(11.5%)。Cox单因素分析结果显示,性别、血磷的差异有统计学意义(P<0.05);多因素Cox风险模型分析显示,基线血磷(HR=0.001,95%CI:0~0.021,P<0.001)是CHB患者发生低磷血症的独立影响因素。基线血磷预测发生低磷血症的AUC为0.7786,预测效能较好,敏感度、特异度分别为88.2%,60.3%。基线血磷≤1.03 mmol/L的CHB患者发生低磷血症累积发生率明显高于基线血磷>1.03 mmol/L的患者(HR=81.79,95%CI:18.581~360.057,P<0.001)。低磷血症患者与eGFR无相关性(r=-0.084,P=0.749)。同时存在低磷血症及eGFR异常的患者,低磷血症的发生时间在eGFR异常后0~1.17年。CHB患者的血磷、eGFR水平呈现下降的趋势。低血磷组患者的血磷水平在随访期间始终低于血磷正常组。结论基线低血磷水平的ETV初治的CHB患者更易发生低磷血症。Objective To investigate the risk factors associated with hypophosphatemia and their dynamic changes in chronic Hepatitis B(CHB)patients treated with Entecavir of initial treatment.Methods 148 CHB patients treated with Entecavir of initial ireatment in the Department of infectious Diseases of the First Affiliated Hospital of Nanchang University from January 2020 to June 2023 were selected.Patients were divided into normal phosphorus group(n=131)and low phosphorus group(n=17)according to serum phosphorus.The Multivariate Cox regression analysis was performed to analyze the independent risk factors of hypophosphatemia in CHB patients.The efficacy of predicting hypophosphatemia in patients with CHB was evaluated with the receiver operating characteristic(ROC)curve.The cumulative incidence of hypophosphatemia was analyzed by Kaplan-Meier analysis and was compared by the Log-rank test.Spearman Correlation was used for correlative analysis.Serum phosphorus and estimated glomerular filtration rate(eGFR)were dynamically observed during treatment.Results Of all 148 patients,17 experienced hypophosphatemia,resulting in hypophosphatemia rate of 11.5%,The results of univariate analysis showed that sex and serum phosphorus at baseline were statistically significant(P<0.05)between the normal group and the low phosphorus group.The multivariate cox regression analysis showed that baseline serum phosphorus(HR=0.001,95%CI:0~0.021,P<0.001)was an independent influencing factor for hypophosphatemia in CHB patients.The area under ROC curve of baseline serum phosphorus was 0.7786,indicating a good prediction efficiency.The optimal cut-off point was 1.03,and the sensitivity and specificity were 88.2%and 60.3%respectively.The cumulative incidence of hypophosphatemia in CHB patients with baseline serum phosphorus≤1.03 mmol/L was significantly higher than that in patients with baseline serum phosphorus>1.03 mmol/L(HR=81.79,95%CI:4.127~28.550,P<0.001).There was no correlation between hypophosphatemia and eGFR(r=-0.084,P=0.749).For all pat

关 键 词：乙型肝炎 慢性 低磷血症 恩替卡韦 

分 类 号：R512.62[医药卫生—内科学]