摘要
目的通过比较长期应用替比夫定或恩替卡韦单药治疗后患者估算肾小球过滤率(e GFR)的变化情况来评价恩替卡韦长期治疗慢性乙型肝炎(CHB)对患者肾功能的影响。方法回顾性队列研究,纳入北京友谊医院62例经抗病毒治疗并随访达208周的CHB患者。其中16例服用替比夫定(600 mg/d,替比夫定组),46例服用恩替卡韦(0.5mg/d,恩替卡韦组)。应用肾脏病膳食改良研究(MDRD)公式计算eGFR。每半年检测肾功能以及病毒学应答的情况,并比较用药前后的e GFR水平,同时分析两组患者早期病毒学应答对e GFR的影响。结果从基线到第208周,在替比夫定组和恩替卡韦组eGFR升高的水平分别为23.81±18.23 ml/(min·1.73 m^2)[基线:81.84±18.49 ml/(min·1.73m^2),P=0.000]、2.66±19.49 ml/(min·1.73 m^2)[基线:89.66±20.59 ml/(min·1.73 m^2),P=0.359]。在服用替比夫定治疗52周时,e GFR有明显改善(P=0.032)。另外,在第52周和第208周时e GFR的变化没有显著性差异(P=0.178)。在替比夫定治疗的第52周和第208周时HBV DNA<20 IU/ml的患者比率分别为81.25%和93.75%,在恩替卡韦治疗的第52周和第208周时HBV DNA<20 IU/ml的患者比率分别为71.74%和78.26%,在治疗52周(P=0.528)和治疗208周(P=0.261)两组间无统计学差异。替比夫定组在26周时获得病毒学应答与否与最终肾功能的改善无关,恩替卡韦组在52周时获得病毒学应答与否亦与最终肾功能的改善无关。结论替比夫定对CHB患者肾功能有潜在的益处,恩替卡韦治疗对慢性乙型肝炎患者的肾功能没有影响。
Objective The aim of this study was to examine the effect of long - term ETV monotherapy on renal function by comparing the eGFR changes during long - term LdT or ETV monotherapy in CHB patients. Methods This retrospective cohort study included 62 Chinese CHB patients with antiviral therapy for 208 weeks in Beijing Friendship Hospital. 16 of these patients had been orally taking LdT （600 mg） dai-ly and 46 of these patients had been orally taking ETV （0.5 mg） daily. The renal function was estimated by eGFR, with MDRD formula. The renal function and HBV DNA were tested every six months. To compare the eGFR levels during treatment and analyze the influence of early viro- logical response on eGFR. Results From baseline to week 208 , the level of eGFR increased 23. 81 ± 18.23 ml/（ min · 1.73 m2 ） （ baseline ： 81. 84 ±18.49 ml/（min . 1.73 m2） ; P =0. 000） and 2. 66 ± 19.49 ml/（min . 1.73 m2） （baseline： 89. 66 ±20. 59 ml/（min . 1.73 m2 ） ; P = 0. 359） in LdT and ETV monotherapy groups, respectively. And the eGFR had been significantly improved after taking LdT for 52 weeks （ P =0.032）. In addition , the changes of eGFR had no significant difference between week 52 and week 208 （ P = 0. 178 ）. 81.25% and 93. 75% of patients treated by LdT achieved HBV DNA 〈20 IU/ml at week 52 and week 208 respectively, and those in patients with ETV monotherapy were 71.74% and 78. 26% , there was no statistic difference between two groups at 52 weeks （ P = 0.528） and 208 weeks （ P = 0. 261）. Whether the virological response was achieved at week 26 in LdT treatment group and at week 52 in ETV treatment group were not associ-ated with the improvement of the final renal function. Conclusion ETV treatment has no influence on renal function in CHB patients. LdT hadthe potential benefit on renal function.
出处
《临床和实验医学杂志》
2017年第15期1502-1505,共4页
Journal of Clinical and Experimental Medicine
基金
首都临床特色应用研究与成果推广(Z171100001017037)
2015年度北京市卫生系统高层次卫生技术人才学科骨干资助项目(2015-3-003)
