阿德福韦酯联合其他核苷（酸）类似物治疗慢性乙型肝炎患者肾功能的变化

doi:10.3969/j.issn.1672-5069.2016.06.008

摘要/Abstract

摘要： 目的以往的研究表明替比夫定（LDT）和阿德福韦酯（ADV）单药治疗可以影响估算肾小球滤过率（eGFR）。本研究的目的是评估以ADV为基础的联合治疗对慢性乙型肝炎（CHB）患者肾功能的影响。方法自2007年2月～2015年10月诊治的164例CHB患者，其中恩替卡韦（ETV）联合ADV治疗42例，拉米夫定（LAM）联合ADV组68例、替比夫定（LDT）联合ADV组54例。比较3组治疗104周时血清肌酐（sCr）、eGFR和eGFR≥90 ml·min^-1·1.73 m²患者构成比的变化，并分析影响患者基线eGFR受损的危险因素。结果在治疗104周时，ETV联合ADV组血清sCr较基线升高（67 μmol/L 对 73 μmol/L，P=0.012），LAM联合ADV组血清sCr较基线也升高（68 μmol/L 对 79 μmol/L，P=0.008）, 而LDT联合ADV组血清sCr水平较基线降低（69 μmol/L 对 64 μmol/L，P=0.023）；ETV联合ADV组eGFR较基线下降（107.8 ml·min^-1·1.73 m² 对96.1ml·min^-1·1.73 m²，P=0.004），LAM联合ADV 104周eGFR较基线下降（105.4 ml·min^-1·1.73 m²对87.3 ml·min^-1·1.73 m²，P=0.000）, 而LDT联合ADV组eGFR较基线升高（104.1ml·min^-1·1.73 m²对116.2 ml·min^-1·1.73 m²，P=0.005）；LDT联合ADV组肾功能正常患者的比例明显高于ETV联合ADV组和LAM联合ADV组（P=0.002，P=0.001）；多因素分析显示，年龄（P=0.035）、男性（P=0.005）、基线eGFR（P<0.001）、LAM联合ADV（P<0.008）、ETV联合ADV（P=0.03）为预测基线eGFR下降>20%的独立危险因素。结论 LDT 联合ADV治疗对肾脏具有保护作用，能改善eGFR，逆转轻度肾功能不全。对肾脏有潜在损伤的患者，可通过应用或联用LDT进行补救治疗。

关键词: 慢性乙型肝炎, 替比夫定, 阿德福韦酯, 肾小球滤过率

Abstract: Objective The precious studies have proved that the monotherapy of telbivudine（LDT） or adefovir dipivoxil （ADV） can influence the estimated glomerular filtration rate（eGFR）. The aims of this study is to assess the effects of combination therapy based on ADV on renal function in patients with chronic hepatitis B （CHB）. Methods The clinical data of 164 patients with CHB in the Department of Infectious Disease，Second Affiliated Hospital，Dalian Medical University between February 2007 and October 2015 were retrospectively analyzed. The study included treatment of entecavir （ETV） combined with ADV（n=42），lamivudine （LAM）combined with ADV（n=68），and telbivudine（LDT） combined with ADV（n=54）. We compared the changes of serum creatinine（sCr），eGFR and we analyzed the risk factors affecting eGFR changes in the patients by Logistic analysis. Results At the end of 104 week treatment， serum sCr level in the group of ETV combined with ADV increased as compared to that at baseline（73 μmol/L versus 67 μmol/L，P=0.012），it alse increased in LAM combined with ADV group（79 μmol/L versus 68 μmol/L，P=0.008），while it decreased in the group of LDT combined with ADV（64 μmol/L versus 69 μmol/L，P=0.023）；The eGFR in the group of ETV combined with ADV decreased （96.1 ml·min^-1·1.73 m² versus 107.8 ml·min^-1·1.73 m²，P=0.004），it alse decreased in LAM combined with ADV group （87.3 ml·min^-1·1.73 m² versus 105.4 ml·min^-1·1.73 m²，P=0.000），however， the eGFR in the group of LDT combined with ADV increased （104.1ml·min^-1·1.73 m² versus 116.2 ml·min^-1·1.73 m²，P=0.005）；the proportion of patients with normal renal function in the group of LDT combined with ADV was higher than that in the group of LAM or ETV combined with ADV（P=0.002，P=0.001）；Logistic analysis showed that age，gender，the baseline eGFR，ETV combined with ADV and LAM combined with ADV were the independent risk factors for predicting eGFR decrease. Conclusion The treatment of LDT combined with ADV might improve the eGFR and protect the renal function. LDT may be a rescue therapy for patients with renal indeficiency.

Key words: Hepatitis B, Telbivudine, Adefovir dipivoxil, Glomerular filtration rate

徐　勇，冯继红，李荣宽，聂振汪，颜悦蓉. 阿德福韦酯联合其他核苷（酸）类似物治疗慢性乙型肝炎患者肾功能的变化[J]. 实用肝脏病杂志, 2016, 19(6): 669-673.

Xu Yong，Feng Jihong，Li Rongkuan，et al.. Changes of renal function in patients with chronic hepatitis B receiving combination of adefovir dipivoxil and other nucleos（t）ide analogues[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2016, 19(6): 669-673.

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