关于阿德福韦酯相关肾损害后换用替比夫定或恩替卡韦治疗的临床观察研究

发布时间：2018-05-14 01:02

本文选题：乙型病毒性肝炎 + 阿德福韦酯　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:观察阿德福韦酯在抗乙型肝炎病毒治疗中对肾功能影响并分析其危险因素,评估患者在出现阿德福韦酯相关肾损害后换用或加用替比夫定、恩替卡韦治疗对肾功能的改善情况。方法:回顾性分析重庆医科大学第二附属医院门诊及住院的慢性乙型病毒性肝病且抗乙型肝炎病毒治疗时间大于2年的患者1007例,按纳入标准排除235名患者,最终入组研究对象包括接受阿德福韦酯治疗的411例(ADV组),恩替卡韦治疗的361例(ETV组),对比两组患者的基线情况,分析两组患者出现肾功能损害的差异,采用Kaplan-Meier法分析长期阿德福韦酯治疗对患者肾功能维持的影响,用COX回归分析肾功能损害的相关因素,卡方检验分析ADV组出现肾功能损害的患者换用或加用替比夫定、换用恩替卡韦治疗后肾功能改善情况及组间差异。结果:两组患者年龄、性别、体重基线水平未能完全匹配,但基线的血清肌酐、内生肌酐清除率、肾小球滤过率均有较好一致性;终点时ADV 组e GFR下降(92.24±25.84 mL.min-1.(1.73 m2)-1)与ETV组(113.14±28.83m L.min-1.(1.73 m2)-1)存在明显差异,前组3.17例/100人年的发病率高于后者的1.64例/100人年;单因素及多因素分析后发现ADV、高血压、糖尿病、HBe Ag阳性、基线低e GFR水平为肾功能损害危险因素;ADV组出现肾功能损害的患者换用或加用LDT、换用ETV治疗后肾功能均得以改善,三种治疗方案间未见明显差异。结论:抗乙型肝炎病毒治疗中阿德福韦酯较恩替卡韦更容易出现肾功能损害,且可作为独立预测因子,合并有高血压或/和糖尿病、HBe Ag阳性、潜在肾功能损害的患者更易出现血清肌酐升高、e GFR降低;ADV相关肾损害患者换用或加用LDT,或换用ETV均能改善肾功能,本研究中暂未观察到两者改善肾功能差异。
[Abstract]:Objective: to observe the effect of adefovir ester on renal function and analyze its risk factors in the treatment of hepatitis B virus, and to evaluate the change or addition of tibivudine in patients with adefovir associated renal damage. Improvement of renal function in patients treated with entecavir. Methods: 1007 patients with chronic hepatitis B liver disease treated for more than 2 years in outpatient and inpatient department of the second affiliated Hospital of Chongqing Medical University were analyzed retrospectively, and 235 patients were excluded according to the inclusion criteria. The subjects of the final study included 411 cases of ADV treated with adefovir and 361 cases of ETV treated with entecavir. The baseline conditions of the two groups were compared, and the difference of renal function impairment between the two groups was analyzed. The effects of long-term adefovir dipivoxil therapy on renal function maintenance were analyzed by Kaplan-Meier method, and the related factors of renal function damage were analyzed by COX regression analysis. Chi-square test was used to analyze the patients with renal function impairment in ADV group who were treated with tibivudine or tibivudine. Renal function improvement and difference between groups after replacement of entecavir. Results: the baseline level of age, sex and body weight was not well matched, but the serum creatinine, endogenous creatinine clearance rate and glomerular filtration rate were all consistent in the two groups. There was significant difference between ADV group (92.24 卤25.84 mL.min-1.(1.73 m2 -1) and ETV group (113.14 卤28.83m L.min-1.(1.73 m2m2m-1) at the end point, the incidence of GFR in the former group was higher than that in the latter group of 1.64 cases / 100 person-years, the positive rate of HBe Ag in the former group was higher than that in the latter group, the univariate and multivariate analysis showed that ADV, hypertension and diabetes mellitus were HBe Ag positive. Baseline low e GFR level was a risk factor for renal function impairment. The renal function of patients with renal dysfunction was improved after ETV treatment. There was no significant difference among the three treatment regimens. Conclusion: adefovir ester is more likely to develop renal function damage than entecavir in anti-hepatitis B virus therapy, and it can be used as an independent predictor of hypertension or / or diabetes mellitus with HBe Ag positive. Patients with potential renal function impairment were more likely to have elevated serum creatinine (creatinine) and lower serum creatinine (GFR). The patients with ADV-related renal damage could improve their renal function by changing or adding LDTs or changing ETV. No difference was found in the improvement of renal function between the two groups.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R512.62

【参考文献】