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

Abstract

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

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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Therapeutic effect and renal function changes of antiviral therapy from lamivudine andadefovir dipivoxil switch to tenofovir in patients with hepatitis B liver cirrhosis

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