不同核苷（酸）类似物治疗慢性乙型肝炎患者对eGFR的影响

doi:10.3969/j.issn.1672-5069.2018.01.012

摘要/Abstract

摘要： 目的本研究旨在研究在接受核苷（酸）类似物（NAs）治疗的慢性乙型肝炎（CHB）患者对估算的肾小球滤过率（eGFR）的影响。方法 40例替诺福韦（TDF）、56例替比夫定（LDT）和68例恩替卡韦（ETV）初治的CHB患者,采用慢性肾脏病流行病学合作研究公式（CKD-EPI）方程对基线和治疗24个月 eGFR进行评估。结果在治疗24个月时,ETV组和TDF组eGFR分别为（89.5±13.2） ml·min^-1·1.73 m^-2和（93.8±13.2） ml·min^-1·1.73 m^-2,均明显较基线下降【分别为（93.4±9.8） ml·min^-1·1.73 m^-2,P=0.041和（98.6±11.2） ml·min^-1·1.73 m^-2,P=0.016】,而LDT组eGFR为（108.5±10.9） ml·min^-1·1.73 m^-2,明显较基线升高【（96.6±10.3） ml·min^-1·1.73 m^-2,P=0.002】;基线时3组患者eGFR构成比无统计学差异（P=0.870）,而在治疗24个月时3组患者eGFR构成比有统计学差异（P=0.028）,LDT组肾功能正常者的比例明显高于ETV和TDF组（P=0.001）,TDF组和ETV组eGFR构成比无统计学差异（P=0.861）;24个月时,ETV和TDF组分别有16.7%（3/18）和44.4%（4/9）基线肾功能正常者进展成eGFR<90 ml·min^-1·1.73 m^-2,而69.2%（9/13）LDT组基线肾功能损伤患者eGFR水平恢复至正常（≥90 ml·min^-1·1.73 m^-2）。结论应用LDT长期治疗CHB患者能改善eGFR水平,而应用TDF和ETV有可能导致eGFR降低。

关键词: 慢性乙型肝炎, 核苷（酸）类似物, 估算的肾小球滤过率

Abstract: Objective To study the impact of nucleos（t）ide analogues on estimated glomerular filtration rate（eGFR） in patients with chronic hepatitis B. Methods A retrospective study of 40 patients treated with tenofovir （TDF）,56 patients with telbivudine （LDT） and 68 patients with entecavir （ETV） were conducted in this study,and all CHB patients were naive,and the eGFR was evaluated by using the Cooperative Formula for Chronic Kidney Disease Epidemiology（CKD-EPI） equation. Results The eGFR in ETV-treated and TDF-treated group at the end of 24 month treatment were （89.5±13.2） ml·min^-1·1.73 m^-2 and （93.8±13.2） ml·min^-1·1.73 m^-2, both significantly lower than those at baseline【（93.4±9.8） ml·min^-1·1.73 m^-2,P=0.041 and （98.6±11.2） ml·min^-1·1.73 m^-2,respectively,P=0.016】,while the eGFR in LDT-treated group was（108.5±10.9） ml·min^-1·1.73 m^-2, significantly higher than that at baseline 【（96.6±10.3） ml·min^-1·1.73 m^-2,P=0.002】;the eGFR in 3 groups at baseline was not statistically significantly different（P=0.870）,while they were statistically significantly different in the three groups as respect to the proportion of eGFR less than 90 ml·min^-1·1.73 m^-2（P=0.028）;at the end of 24 month treatment,16.7% （3/18） in ETV-treated, and 44.4% （4/9） in TDF-treated groups with normal renal function at baseline progressed to eGFR <90 ml·min^-1·1.73 m^-2,while 69.2% （9/13） of LDT-treated patients with renal impairment at baseline got renal function returned to normal （≥90 ml·min^-1·1.73 m^-2）. Conclusion The long-term application of LDT might have a protective effect on renal function, whereas the administration of TDF and ETV might result in decreased of eGFR.

Key words: Hepatitis B, Nucleos（t）ide analogue, Estimated glomerular filtration rate

徐勇, 冯继红, 李荣宽, 聂振汪, 杨小舟. 不同核苷（酸）类似物治疗慢性乙型肝炎患者对eGFR的影响[J]. 实用肝脏病杂志, 2018, 21(1): 50-53.

Xu Yong, Feng Jihong, Li Rongkuan, et al. Impact of nucleos（t）ide analogues on eGFR in patients with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2018, 21(1): 50-53.

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