欢迎访问《中国临床药理学与治疗学》杂志官方网站,今天是

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (9): 1029-1034.

• 药物治疗学 • 上一篇    下一篇

长期应用核苷(酸)类药物治疗对慢乙肝患者肾功能的影响

霍 娜,陆海英,王贵强,黄明杰,吴赤红,蔺小红   

  1. 北京大学第一医院感染疾病科,北京 100034
  • 收稿日期:2016-09-27 修回日期:2016-11-11 出版日期:2017-09-26 发布日期:2017-09-30
  • 通讯作者: 陆海英,女,主任医师,副教授,主要从事病毒性肝炎的研究。 E-mail:luhaiying00@126.com
  • 作者简介:霍娜,女,博士研究生,主要从事病毒性肝炎的研究。
  • 基金资助:

    国家十二五科技重大专项资助项目 (2012ZX10002003)

Effects of nucleos(t)ide analogues on renal function in patients with chronic hepatitis B

HUO Na, LU Haiying, WANG Guiqiang, HUANG Mingjie, WU Chihong, LIN Xiaohong   

  1. Department of Infectious Disease, Peking University First Hospital, Beijing 100034, China
  • Received:2016-09-27 Revised:2016-11-11 Online:2017-09-26 Published:2017-09-30

摘要:

目的: 总结长期应用核苷(酸)类药物抗病毒治疗对肾脏功能的影响。方法: 记录176例长期应用核苷(酸)类药物抗病毒治疗的慢乙肝患者[阿德福韦酯(ADV)+ 拉米夫定(LAM)治疗组28例,阿德福韦酯(ADV)+ 恩替卡韦(ETV)组20例,LAM组21例,ADV组26例,ETV组81例]的临床资料,并计算eGFR。采用Kruskal-Wallis检验、MannWhitney检验、χ2检验进行差异性比较分析。结果: ADV+LAM治疗组、ADV+ETV组、LAM组、ADV组、ETV组患者的eGFR分别为:(78.9±13.8)、(80.2±15.8)、(78.8±12.9)、(74.6±14.6)、(79.5±13.1) mL·min-1·1.73 m-2,P>0.05;eGFR<80 mL·min-1·1.73 m-2的病例数分别为14(50%)、12(60%)、10(47.6%)、20(69.2%)、47(58.0%),P>0.05;血清磷水平分别为(0.95±0.14)、(0.92±0.11)、(1.02±0.13)、(0.92±0.16)、(0.97±0.14) mmol/L;血清磷降低的病例数分别为15(53.6%)、13(65%)、6(28.6%)、13(50%)、39(48.1%),而且LAM组与ADV+ETV组相比,χ2 = 5.466 9,P=0.019 4。结论: 长期核苷(酸)类药物抗病毒治疗可影响肾脏功能,其中ADV的影响最明显,ETV次之,LAM最轻,而且监测eGFR和血清磷水平能更敏感地反映肾脏受损情况。

关键词: 肾小球滤过率估算值(eGFR), 肾损害, 拉米夫定, 阿德福韦酯, 恩替卡韦

Abstract:

AIM: To summarize the effects of nucleoside (acid) drugs on renal function in accepting antiviral therapy chronic hepatitis B patients.  METHODS: Clinical data of 176 cases of chronic hepatitis B patients treated with nucleoside (acid) antiviral therapy (28 cases in ADV+LAM treatment group, 20 cases in ADV+ETV group, 21 cases in LAM group, 26 cases in ADV group, 81 cases in group ETV) were recorded, estimated glomerular filtration rate (eGFR) was calculated. The Kruskal-Wallis test or Mann-Whitney test or chi square difference test were used for comparative analysis of differences.RESULTS:The eGFR of the patients in ADV+LAM treatment group, ADV+ETV group, LAM group, ADV group and ETV group were (78.9±13.8),(80.2±15.8),(78.8±12.9),(74.6±14.6),(79.5±13.1) mL·min-1·1.73 m-2, respectively, P>0.05; the number of cases with eGFR less than 80 mL·min-1·1.73 m-2 were  14(50%), 12(60%), 10(47.6%), 20(69.2%), 47(58.0%), respectively, P>0.05. Serum phosphorus levels were (0.95±0.14),(0.92±0.11),(1.02±0.13),(0.92±0.16),(0.97±0.14)mmol/L, respectively, P>0.05; the number of cases with a decreased serum phosphorus level were 15(53.6%), 13(65%), 6(28.6%), 13(50%), 39(48.1%), respectively; Furthermore, there were statistically significant differences between LAM group and ADV+ETV group (χ2=5.466 9, P=0.019 4). CONCLUSION: Long-term antiviral therapy of nucleoside (acid) drugs may affect renal function, in which the effect of ADV is the most obvious, ETV is the second, and LAM is the mildest. The monitoring of eGFR and serum phosphorus level is more sensitive to reveal the damage of kidney.

Key words: estimated glomerular filtration rate, renal damage, lamivudine, adefovir, entecavir

中图分类号: