核苷和核苷酸类药物对慢性乙型肝炎患者肾小球滤过率和血肌酐水平的影响

徐勇; 冯继红

doi:10.3969/j.issn.1001-5256.2016.02.016

核苷和核苷酸类药物对慢性乙型肝炎患者肾小球滤过率和血肌酐水平的影响

DOI: 10.3969/j.issn.1001-5256.2016.02.016

徐勇,
冯继红

1. 通城县人民医院感染科
2. 大连医科大学附属第二医院感染科

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中图分类号: R512.62
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出版历程
- 收稿日期: 2015-06-05
- 出版日期: 2016-02-20

Effects of nucleos(t) ide analogues on estimated glomerular filtration rate and serum creatinine level in patients with chronic hepatitis B

Department of Infectious Diseases,Tongcheng People's Hospital

摘要

摘要: 目的研究核苷和核苷酸类药物（NAs）对慢性乙型肝炎（CHB）患者肾小球滤过率（e GFR）和血肌酐（Scr）的影响。方法收集2010年9月-2014年9月在大连医科大学附属第二医院感染科门诊及住院的CHB患者184例,根据应用NAs的不同将其分为3组,分别为阿德福韦酯（ADV）组（n=58）、替比夫定（LDT）组（n=62）和恩替卡韦（ETV）组（n=64）,疗程均为104周。比较治疗前后各组e GFR、Scr水平的变化。计量资料组内治疗前后比较采用Wilcoxon秩和检验,多组间比较采用Kruskal-Wallis H秩和检验,计数资料组间比较采用χ2检验。结果 ETV组治疗52、104周后Scr、e GFR变化均不明显,与基线相比差异无统计学意义（P值均>0.05）;与基线水平相比,ADV组治疗52、104周的Scr水平升高,e GFR水平降低,差异均有统计学意义（Z值分别为-3.020、-3.456、-4.623、-4.831,P值分别为0.018、0.008、0.004、<0.001）;LDT组治疗52、104周的Scr水平较基线降低,e GFR较基线升高,差异均有...
- 肝炎,乙型,慢性 /
- 核苷类 /
- 核苷酸类 /
- 肾小球滤过率
Abstract: Objective To investigate the effects of nucleos( t) ide analogues( NAs) on the estimated glomerular filtration rate( e GFR) and serum creatinine( Scr) in patients with chronic hepatitis B( CHB). Methods A total of 184 patients with CHB who visited and were hospitalized in the Second Affiliated Hospital of Dalian Medical University from September 2010 to September 2014 were enrolled and divided into adefovir( ADV) group( 58 patients),telbivudine( LDT) group( 62 patients),and entecavir( ETV) group( 64 patients),according to the NAs administered. The course of treatment was 104 weeks for all groups. The changes in e GFR and Scr level in each group after treatment were evaluated. The chi- square test was applied for comparison of categorical data between groups; the Wilcoxon rank sum test was applied for comparison of continuous data before and after treatment within one group,and Kruskal- Wallis H rank sum test was applied for comparison between groups. Results In the ETV group,there were no significant changes in Scr and e GFR after 52 and 104 weeks of treatment( all P > 0. 05); in the ADV group,there was a significant increase in Scr level and a significant reduction in e GFR after 52 and 104 weeks of treatment( Z =- 3. 020,- 3. 456,- 4. 623,and- 4. 831,P = 0. 018,0. 008,0. 004,and < 0. 001,respectively); in the LDT group,there was a significant reduction in Scr level and a significant increase in e GFR after 52 and 104 weeks of treatment( Z =-5. 596,- 5. 687,- 5. 335,and- 5. 162,P = 0. 007,0. 003,0. 002,and < 0. 001,respectively). After 104 weeks of treatment,the distribution of e GFR showed a significant difference between the ADV group and the LDT group( χ2= 21. 039,P < 0. 001); in the LDT group,77. 78%( 7 /9) of all the patients achieved e GFR ≥90 ml·min- 1·1. 73 m- 2,and in the ADV group,23. 81%( 10 /42) of all the patients achieved e GFR < 90 ml·min- 1·1.73 m- 2. Conclusion During the treatment,LDT can increase e GFR and improve renal function significantly,while ADV may reduce e GFR,with potential nephrotoxicity. During the treatment for patients with CHB,e GFR may reflect renal injury much earlier than Scr. The mechanisms of action of LDT in increasing e GFR and protecting renal function await further investigation.
- hepatitis B,chronic /
- nucleosides /
- nucleotides /
- glomerular filtration rate

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参考文献(16)

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