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长期口服抗病毒药物的慢性乙型肝炎患者肾功能指标异常的影响因素分析

宁会彬 靳慧鸣 李宽 彭真 李威 尚佳

宁会彬,靳慧鸣,李宽,等. 长期口服抗病毒药物的慢性乙型肝炎患者肾功能指标异常的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(8): 1798-1801. DOI: 10.3969/j.issn.1001-5256.2021.08.011
引用本文: 宁会彬,靳慧鸣,李宽,等. 长期口服抗病毒药物的慢性乙型肝炎患者肾功能指标异常的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(8): 1798-1801. DOI: 10.3969/j.issn.1001-5256.2021.08.011
NING HB, JIN HM, LI K, et al. Influencing factors for abnormal renal function markers in chronic hepatitis B patients receiving long-term oral administration of entecavir/tenofovir disoproxil fumarate[J]. J Clin Hepatol, 2021, 37(8): 1798-1801. DOI: 10.3969/j.issn.1001-5256.2021.08.011
Citation: NING HB, JIN HM, LI K, et al. Influencing factors for abnormal renal function markers in chronic hepatitis B patients receiving long-term oral administration of entecavir/tenofovir disoproxil fumarate[J]. J Clin Hepatol, 2021, 37(8): 1798-1801. DOI: 10.3969/j.issn.1001-5256.2021.08.011

长期口服抗病毒药物的慢性乙型肝炎患者肾功能指标异常的影响因素分析

DOI: 10.3969/j.issn.1001-5256.2021.08.011
基金项目: 

“十三五”国家科技重大专项 2018ZX10302205-004

详细信息
    通讯作者:

    尚佳,shangjia666@126.com

  • 中图分类号: R512.62

Influencing factors for abnormal renal function markers in chronic hepatitis B patients receiving long-term oral administration of entecavir/tenofovir disoproxil fumarate

Funds: 

National Key R&D Program of China 2018ZX10302205-004

  • 摘要:   目的  探讨长期口服抗病毒药物的慢性乙型肝炎患者肾功能指标异常情况及影响因素。  方法  回顾性收集2019年1月— 2019年12月河南省人民医院就诊长期口服恩替卡韦(ETV)或富马酸替诺福韦(TDF)的681例慢性乙型肝炎患者的临床资料。所有患者均进行血液肾功能[尿素、肌酐、视黄醇结合蛋白(RBP)、血胱抑素C(Cys C)、β2微球蛋白(β2-MG)]、尿液肾功能[尿α1-微球蛋白(α1-MG)、尿Cys C、尿N-已酰-β-D-氨基葡萄糖苷酶(NAG)]及尿常规检测。分析患者肾功能指标异常发生率。计数资料组间比较采用McNemar’s检验。利用多因素logistic回归筛选慢性乙型肝炎患者尿液中肾指标异常发生的独立影响因素。  结果  681例患者平均年龄(39.8±11.0)岁,平均用药1.88(0.80~3.16)年;男性417例,女性264例;肝硬化发生率27.02%(184/681),ETV与TDF用药患者分别为442例、239例。血肾功能检测项目异常率分别为尿素6.9%(47/681)、肌酐0.15%(1/681)、RBP 0(0/681)、血Cys C 2.21%(15/681)、β2-MG 5.03%(30/681),尿蛋白异常情况为7.29%(49/672),尿肾功能检测项目异常率分别为α1-MG 38.62%(263/681)、NAG 37.74%(257/681)、尿Cys C 19.38%(132/681)。尿检异常率高于血检(P<0.001)。以尿α1-MG作为因变量进行多因素logistic回归分析结果显示,性别(OR=0.293, 95%CI:0.204~0.419)、年龄(OR=1.298, 95%CI:1.108~1.521)、核苷药物种类(OR=2.100, 95%CI:1.431~3.083)为其影响因素(P值均<0.05)。以尿NAG作为因变量进行多因素logistic回归分析结果显示, 年龄(OR=1.177, 95%CI:1.008~1.375,P=0.040)为其影响因素。  结论  尿肾功能检测指标(尤其是尿α1-MG和尿NAG)比血液检测指标更能早期发现慢性乙型肝炎患者肾损伤,老年男性患者及接受TDF治疗者更容易出现肾功能异常,未观察到用药时长及肝硬化增加慢性乙型肝炎患者肾损伤的发生风险。

     

  • 表  1  血BUN检测与尿Cys C检测异常情况比较

    指标 尿Cys C检测 合计
    异常 正常
    血BUN检测 异常 6 41 47
    正常 126 508 634
    合计 132 549 681
    注:配对McNemar’s检验,P<0.001。
    下载: 导出CSV

    表  2  681例CHB患者尿α1-MG异常的多因素logistic回归分析

    变量 β SE Wald χ2 P OR(95%CI)
    性别 -1.228 0.184 44.816 <0.001 0.293(0.204~0.419)
    年龄 0.261 0.081 10.381 0.001 1.298(1.108~1.521)
    核苷药物种类 0.742 0.196 14.353 <0.001 2.100(1.431~3.083)
    常数项 -0.995 0.256 13.908 <0.001 0.385
    下载: 导出CSV
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  • 收稿日期:  2020-12-24
  • 修回日期:  2021-01-26
  • 刊出日期:  2021-08-16
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