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替比夫定改善慢性乙型肝炎患者肾小球滤过率估计值水平

发表时间:2015-03-15  浏览量:1809  下载量:582
全部作者: 戚勋,王瑾瑜,毛日成,张继明
作者单位: 复旦大学附属华山医院感染科
摘 要: 目的:观察慢性乙型肝炎(chronic hepatitis B,CHB)初治患者长期服用核苷(酸)类药物单药治疗后的肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)变化。方法:利用一项慢性CHB例数为275例的前瞻性队列进行研究。病人队列包括:拉米夫定治疗患者50例,阿德福韦酯治疗患者60例,替比夫定治疗患者68例,恩替卡韦治疗患者61例,未治疗患者36例作为对照。同时运用Cockcroft-Gault(CG)和MDRD公式计算eGFR. 结果:经过平均23个月的随访,使用替比夫定治疗的患者eGFR较基线时上升18.35 mL/min(CG)和19.34 mL/min(MDRD)(P < 0.000 1),使用阿德福韦酯治疗的患者eGFR较基线时下降10.95 mL/min(CG)和12.17 mL/min(MDRD)(P = 0.000 1),不论是基线时有肾功能受损的患者还是基线时正常的患者,服用替比夫定后eGFR均上升明显(P < 0.000 1)。服用替比夫定的患者eGFR上升幅度大于20%的比例最多(31%),较其他各组有明显统计学差异(P < 0.00 1);反之,服用阿德福韦酯的患者eGFR下降幅度大于20%的比例最多(23%),较其他各组有明显统计学差异(P < 0.000 1)。结论:长期服用替比夫定可以改善慢性乙型肝炎患者的eGFR水平,而阿德福韦酯降低eGFR,拉米夫定和恩替卡韦对eGFR无显著影响。
关 键 词: 传染病学;核苷类药物;肾小球滤过率估计值;慢性乙型肝炎
Title: Telbivudine improves estimated glomerular filtration rate in patients with chronic hepatitis B
Author: QI Xun, WANG Jinyu, MAO Richeng, ZHANG Jiming
Organization: Department of Infectious Diseases, Huashan Hospital, Fudan University
Abstract: Objective: To evaluate the long-term effects of nucleoside/nucleotide analogues on estimated glomerular filtration rate (eGFR) in Chinese chronic hepatitis B (CHB) patients. Methods: This prospective cohort study included 275 CHB patients. Patient subgroups included those treated with lamivudine (n = 50), adefovir (n = 60), telbivudine (n = 68), and entecavir (n = 61); untreated patients (n = 36) served as control. The data was calculated by Cockcroft-Gault (CG) and MDRD formulas. Results: After an average follow-up duration of 23 months, eGFR calculated by CG and MDRD formulas increased by 18.35 mL/min and 19.34 mL/min (P < 0.000 1) in the telbivudine group, respectively, and decreased by 10.95 mL/min and 12.17 mL/min (P = 0.000 1) in the adefovir group, respectively. Even if renal function was normal or mildly impaired at baseline, eGFR increased significantly more in the telbivudine group than in the other groups (P < 0.000 1). More patients in the telbivudine group (31%) had a ≥20% elevation in eGFR (CG) than the other groups (P < 0.000 1). More patients in the adefovir group (23%) had a ≥20% decrease in eGFR (CG) than the other groups (P < 0.000 1). Conclusion: Prolonged telbivudine therapy results in improved eGFR, while adefovir therapy is associated with decreased eGFR. Lamivudine and entecavir therapy do not significantly influence eGFR.
Key words: infectious disease; nucleoside/nucleotide analogues; estimated glomerular filtration rate; chronic hepatitis B
发表期数: 2015年3月第5期
引用格式: 戚勋,王瑾瑜,毛日成,等. 替比夫定改善慢性乙型肝炎患者肾小球滤过率估计值水平[J]. 中国科技论文在线精品论文,2015,8(5):458-467.
 
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