阿德福韦酯治疗乙型病毒性肝炎后引起肾功能损害的研究分析

发布时间：2018-06-03 07:00

本文选题：阿德福韦酯 + 恩替卡韦　；参考：《浙江大学》2014年硕士论文

【摘要】：目的：比较阿德福韦酯(ADV)与恩替卡韦(ETV)治疗慢性乙型病毒性肝炎后患者病毒学、血清学及肾功能的改变,并分析阿德福韦酯相关性肾损害的危险因素。方法：回顾性分析接受阿德福韦酯治疗(n=45,其中7例ADV单药治疗,38例联合拉米夫定(LAM)抗病毒治疗)及恩替卡韦单药治疗(n=45)服药两年以上的患者共90例,比较两组患者接受抗病毒治疗后12周、24周、48周、72周、96周乙型肝炎病毒(HBV) DNA阴转率,乙型肝炎病毒e抗原(HBeAg)转换率,谷丙转氨酶(ALT)复常率、血清肌酐、肾小球率过滤等指标的变化情况,并分析ADV组中尿微量蛋白(尿免疫球蛋白IgG、尿微量白蛋白、视黄醇结合蛋白(RBP)和尿β2微球蛋白)的变化。结果：阿德福韦酯组及恩替卡韦组治疗96周时乙肝DNA阴转率分别为82.8%和93.3%(p0.05), HBeAg阴转率分别为44%和47.8%(p0.05),ALT复常率分别为88.9%和93%(p0.05),血肌酐较基线变化值分别为+18.2umol/L和+2.5umol/L (p0.05),肾小球率过滤较基线变化值分别为-14.6ml/min/1.73m2和-1.6ml/min/1.73m2(p0.05);阿德福韦酯治疗组中有8名患者出现尿β2微球蛋白异常,9名患者RBP升高；出现尿微量蛋白检测异常的患者与同组另32名患者在年龄、抗病毒治疗时间上有显著差异(P0.05),与体重、性别、基线eGFR和肌酐无明显差异。结论：恩替卡韦在降HBV DNA及肾脏功能影响方面显著优于阿德福韦酯治疗组,两治疗组HBeAg阴转率及ALT复常率无明显差异；长期服用阿德福韦酯治疗可引起肾功能损害,表现为肾小球滤过率下降,血肌酐上升,尿微量蛋白上升等,其中尿微量蛋白出现更早；阿德福韦酯相关肾损害可能与患者年龄、服用阿德福韦酯时间有关。
[Abstract]:Aim: to compare the changes of virology, serology and renal function in patients with chronic hepatitis B treated with adefovir (ADV) and entecavir (ETV), and to analyze the risk factors of renal damage associated with adefovir. Methods: a retrospective analysis was made of 90 patients who received adefovir dipivoxil for more than two years, including 7 patients treated with ADV alone and 38 patients treated with lamivudine) for more than two years. The conversion rate of DNA, HBeAg, alt, creatinine and serum creatinine were compared between the two groups at 12 weeks, 24 weeks and 48 weeks and 72 weeks and 96 weeks, respectively. The changes of urinary microproteins (IgG, albumin, retinol binding protein) and 尾 2 microglobulin (尾 2 microglobulin) in ADV group were analyzed. Results: at 96 weeks after treatment with adefovir dipivoxil and entecavir group, the negative conversion rates of DNA and HBeAg were 82.8% and 93.3%, respectively. The negative conversion rates of HBeAg were 44% and 47.8%, respectively, and the recovery rates of alt were 88.9% and 93%, respectively. The serum creatinine levels were 18.2umol/L and 2.5umol/L p0.05, respectively. The changes of microsphere filtration rate compared with baseline were -14.6 ml / min / 1.73 m2 and -1.6 ml / min / 1.73 m ~ (2) P 0.05, respectively. In the adefovir group, there were 8 patients with abnormal urinary 尾 _ 2-microglobulin and 9 patients with elevated RBP in the adefovir group. There were significant differences in age and time of antiviral therapy between patients with abnormal urine microprotein detection and 32 patients in the same group. There was no significant difference in age, age and time of antiviral therapy between patients with abnormal urine microprotein detection and with body weight, sex, baseline eGFR and creatinine. Conclusion: entecavir is superior to adefovir in decreasing HBV DNA and renal function. There is no significant difference in negative conversion rate of HBeAg and return rate of ALT between the two groups, and long-term treatment with adefovir can cause renal function damage. The results showed that glomerular filtration rate decreased, serum creatinine increased, urine microprotein increased, and urine microprotein appeared earlier. The renal damage associated with adefovir ester may be related to the age of patients and the duration of adefovir administration.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62

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