LAM和ADV长期联合后转换为替诺夫韦治疗乙型肝炎肝硬化患者疗效及其对肾功能的影响

doi:10.3969/j.issn.1672-5069.2020.05.025

摘要/Abstract

摘要： 目的探讨长期联合应用拉米夫定(LAM)和阿德福韦酯(ADV)后转换为替诺夫韦治疗乙型肝炎肝硬化患者疗效及其对肾功能的影响。方法 2015年2月～2018年2月我院收治的乙型肝炎肝硬化患者130例,纳入患者均经过LAM联合ADV治疗至少5年以上(5～8年)。采用随机数字表法将患者分成观察组(n=65)和对照组(n=65)。在对照组,继续应用LAM联合ADV治疗,而在观察组,改用替诺夫韦治疗,观察12个月。采用电化学发光免疫法检测血清25-羟维生素水平,使用流式细胞仪检测外周血辅助性T细胞17(Th17)和调节性T细胞(Treg)百分比,并计算Th17/Treg细胞比值。检测血清肌酐(Cr)和尿素(Urea),并计算估算的肾小球滤过率(eGFR)。结果在治疗12个月末,观察组血清HBV DNA水平为(2.3±0.7)lg IU/mL,显著低于对照组,Child评分为(6.3±1.4),显著低于对照组【(8.2±1.3),P＜0.05】;观察组血清25-(OH)D₃水平为(26.8±2.1)ng/ml,显著高于对照组,外周血Treg细胞百分比为(3.4±0.6)%,显著高于对照组,Th17细胞百分比为(2.1±0.3)%,显著高于对照组,而Th17/Treg细胞比值为(0.3±0.1),显著低于对照组;观察组血清Cr水平为(0.80±0.07)mg/dl,显著低于对照组,Urea水平为(11.27±4.36)mmol/L,显著低于对照组,而eGFR为(103.72±11.74)mL/(min·1.73m²),显著高于对照组。结论对早期应用了LAM联合ADV治疗的乙型肝炎肝硬化患者及时转换为替诺夫韦治疗,能进一步提高血清HBV DNA转阴率,改善免疫功能,对肾功能具有保护作用,其长期疗效还需要进一步观察。

关键词: 肝硬化, 乙型肝炎, 替诺夫韦, 拉米夫定, 阿德福韦酯, 肾功能, 治疗 , ,

Abstract: Objective The aim of this study was to investigate therapeutic effect and renal function changes of antiviral therapy from lamivudine (LAM)and adefovir dipivoxil (ADV) switch to tenofovir in patients with hepatitis B liver cirrhosis (LC). Methods 130 patients with hepatitis B liver cirrhosis were enrolled in this study between February 2015 and February 2018, and all of them had received LAM and ADV combination therapy for longer than 5 years. The patients were randomly divided into observation (n=65) and control group (n=65) by randomized numbers generated by computer. The patients in the control group received LAM and ADV for further treatment, and those in the observation group were treated with tenofovir for 12 months. Serum levels of 25-hydroxyvitamin , and peripheral blood helper T cell 17 (Th17) and regulatory T (Treg) cells were measured. Serum creatinine (Cr) and urea levels as well as estimated glomerular filtration rate (eGFR) were measured and calculated. Results At the end of 12-month observation and in the tenofovir-treated patients, serum HBV DNA load was (2.3±0.7)lg IU/mL, significantly lower than , Child-Pugh score was (6.3±1.4), much lower than in the control; serum 25-(OH)D₃ level was (26.8±2.1)ng/ml, significantly higher than , the percentage of peripheral blood Treg cell was (3.4±0.6)%, significantly higher than , that of Th17 cell was (2.1±0.3)%, significantly higher than , while the ratio of Th17/Treg cells was (0.3±0.1), significantly lower than in the control; serum Cr level was (0.80±0.07)mg/dl, significantly lower than , serum urea level was (11.27±4.36)mmol/L, significantly lower than , while eGFR was (103.72±11.74)mL/(min·1.73m²), significantly higher than in the control. Conclusion The long-term LAM and ADV combination therapy for hepatitis B liver cirrhosis might damage renal functions, and switch to tenofovir treatment at a appropriate time for further antiviral therapy might protect renal functions and help the patients get benefits.

Key words: Liver cirrhosis, Hepatitis B, Tenofovir, Lamivudine, Adefovir dipivoxil, Renal functions, Therapy

陆长春, 丁敏侠, 段作斌, 蔺咏梅. LAM和ADV长期联合后转换为替诺夫韦治疗乙型肝炎肝硬化患者疗效及其对肾功能的影响[J]. 实用肝脏病杂志, 2020, 23(5): 703-706.

Lu Changchun, Ding Minxia, Duan Zuobin, et al.. Therapeutic effect and renal function changes of antiviral therapy from lamivudine andadefovir dipivoxil switch to tenofovir in patients with hepatitis B liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(5): 703-706.

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