来氟米特、甲泼尼龙联合恩替卡韦在乙肝病毒相关性肾炎治疗中的应用

发布时间：2018-08-07 18:49

【摘要】：目的应用来氟米特、甲泼尼龙联合恩替卡韦治疗乙肝病毒相关性肾炎(HBV-GN),对比单独应用恩替卡韦抗病毒治疗,探讨来氟米特、甲泼尼龙联合恩替卡韦治疗乙肝病毒相关性肾炎(HBV-GN)的效果及安全性。方法选择2014年1月—2015年12月间37例住院HBV-GN患者,均经肾穿刺活检确诊,其中21例治疗组应用来氟米特、甲泼尼龙联合恩替卡韦治疗,16例对照组仅恩替卡韦抗病毒治疗。治疗3个月、6个月后比较2组患者尿蛋白减少情况、谷丙转氨酶(ALT)指标以及HBV-DNA复制水平。结果治疗3个月后,治疗组患者尿蛋白(1.76±1.20)g/24 h,显著优于对照组(2.70±1.50)g/24 h,(P0.05),治疗6个月后,治疗组患者尿蛋白(1.61±0.90)g/24 h,显著优于对照组(2.34±1.20)g/24 h,差异有统计学意义(P0.05),ALT(17.0±6.3)U/L与对照组(19.7±4.0)U/L相比差异无统计学意义(P0.05),3个月抗病毒治疗后监测2组患者HBV-DNA水平均在正常范围;ALT(19.0±4.7)U/L与对照组(18.3±4.4)U/L相比差异无统计学意义(P0.05),2组HBVDNA水平均在正常范围。结论乙肝病毒相关性肾炎的治疗目前临床上并无统一意见,患者常因尿蛋白难以得到控制而在数年内进展至终末期肾病,患者生活质量的明显下降甚至危及生命,而且对国家医疗保险造成了沉重负担。来氟米特、甲泼尼龙联合恩替卡韦在HBV-GN治疗中的效果以及安全性目前仍不明确,通过本次研究,希望为HBV-GN诊治思路提供依据。
[Abstract]:Objective to evaluate the efficacy of entecavir combined with methylprednisolone in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN). Efficacy and safety of methylprednisolone combined with entecavir in the treatment of hepatitis B virus associated glomerulonephritis (HBV-GN). Methods from January 2014 to December 2015, 37 patients with HBV-GN were selected and confirmed by renal biopsy. Among them, 21 patients in the treatment group should be treated with flunomide and 16 patients in the control group treated with methylprednisolone combined with entecavir alone. After 3 months and 6 months of treatment, the levels of urinary protein, alanine aminotransferase (ALT) and HBV-DNA replication were compared between the two groups. Results after 3 months of treatment, urinary protein in the treatment group was (1.76 卤1.20) g / r 24 h, significantly higher than that in the control group (2.70 卤1.50) g / r 24 h (P0.05). Urine protein in the treatment group (1.61 卤0.90) g / 24 h was significantly higher than that in the control group (2.34 卤1.20) g / 24 h, the difference was statistically significant (P0.05). There was no significant difference in alt (17.0 卤6.3) UL and (19.7 卤4.0) U / L between the control group and the control group (P0.05). After 3 months of antiviral therapy, the HBV-DNA levels of the two groups were significantly higher than those of the control group (19.0 卤4.7) U / L and (19.0 卤4.7) U / L respectively (P0.05). There was no significant difference in HBVDNA levels between the two groups (18.3 卤4.4) U / L (P0.05). Conclusion there is no consensus in the treatment of hepatitis B virus associated glomerulonephritis. The patients often develop to end-stage nephropathy in a few years due to the difficulty of controlling urinary protein. The quality of life of the patients is significantly decreased or even life-threatening. And a heavy burden on national health insurance. The efficacy and safety of leflunomide, methylprednisolone and entecavir in the treatment of HBV-GN are still unclear. Through this study, we hope to provide evidence for the diagnosis and treatment of HBV-GN.
【作者单位】：蚌埠医学院第一附属医院肾内科;
【基金】：安徽省教育厅自然科学基金(KJ2015B021by)
【分类号】：R512.62;R692.3

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