替比夫定治疗乙型肝炎肝硬化失代偿疗效分析及对肾脏功能的影响

发布时间：2019-08-12 17:41

【摘要】：目的评价替比夫定治疗乙型肝炎肝硬化失代偿患者的疗效及对肾脏功能的影响。方法回顾性分析2012年4月至2015年11月在上海市松江区中心医院感染科就诊的失代偿期乙型肝炎肝硬化患者72例,给予替比夫定抗病毒治疗,在治疗后24周、48周观察血清丙氨酸氨基转移酶(ALT)、血清总胆红素(TBil)、白蛋白(Alb)、凝血酶原时间(PT)、Child-Pugh积分、腹水、HBV DNA、阴转率及耐药变异率;比较治疗后24周、48周血清肌酐(CR),估算肾小球滤过率(eGFR)较基线的变化情况。计量资料比较采用独立样本t检验,治疗前后比较采用配对t检验,计数资料采用x~2检验。结果治疗24周时,血清ALT、TBil、HBV DNA载量均值分别为:46.12 U/L、44.31μmol/L和1.89 lg拷贝/mL,HBV DNA阴转率为75.00%,均较治疗前有明显改善(P0.05)。2例患者出现耐药变异,但未发现有腹水消失的病例;随着治疗时间延长至48周,Alb水平和PT均值分别为:34.16 g/L和1 5.09 s,Child-Pugh积分也较治疗前进一步明显改善(P0.05),有3例患者腹水消失且耐药变异病例增加至5例。治疗48周时eGFR及CR分别为:108.48 mL/(min·1.73 m~2)和0.83 mg/dL,均较治疗前明显改善(P(.05),39例基线肾功能轻度受损[eGFR 60~90 mL/(min·1.73 m~2)]患者中,有9例患者(23.08%)上升至eGFR≥90mL/(min·1.73 m~2)。结论替比夫定治疗乙型肝炎肝硬化失代偿期患者在有效抑制病毒及改善肝脏储备功能方面疗效肯定,随着治疗时间的延长治疗效果更加明显,但有部分患者出现耐药变异;替比夫定有改善肾脏功能的作用,对于基线肾功能受损的患者,其肾脏功能可得到一定程度的恢复。
[Abstract]:Objective to evaluate the efficacy of tibivudine in the treatment of decompensated patients with hepatitis B liver cirrhosis and its effect on renal function. Methods from April 2012 to November 2015, 72 patients with decompensated hepatitis B liver cirrhosis were treated with tibivudine antiviral therapy. Serum alanine aminotransferase (ALT), serum total bilirubin (TBil), albumin (Alb), prothrombin time (PT), Child-Pugh score and ascitic, HBV DNA, were observed 24 weeks and 48 weeks after treatment. Negative conversion rate and drug resistance mutation rate; The changes of renal filtration rate (eGFR) estimated by serum creatine (CR), at 24 weeks and 48 weeks after treatment were compared with those at baseline. Independent sample t test was used to compare the econometric data, pairing t test was used before and after treatment, and x 鈮，

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