三种核苷类似物对慢性乙型肝炎患者肾功能影响的长期随访研究

目的：探讨替比夫定、恩替卡韦和阿德福韦酯治疗慢性乙型肝炎疗效及对肾功能的影响。方法抽取2011年1月—2014年1月分别行替比夫定（替比夫定组）、恩替卡韦（恩替卡韦组）和阿德福韦酯（阿德福韦酯组）治疗的慢性乙型肝炎患者各40例，共干预104周，比较临床疗效、不良反应及治疗前后肾功能指标。结果替比夫定组治疗104周HBV-DNA阴转率、HBeAg血清学转换率、总有效率均显著高于阿德福韦酯组（P﹤0.05）。恩替卡韦组HBV-DNA阴转率、ALT复常率及总有效率均明显高于阿德福韦酯组（P﹤0.05）。3组治疗104周替比夫定组和恩替卡韦组血肌酐水平明显低于阿德福韦酯组，且替比夫定组低于恩替卡韦组（P﹤0.05）；估计肾小球滤过率明显高于阿德福韦组，且替比夫定组高于恩替卡韦组（P﹤0.05）。3组不良反应发生率比较差异无统计学意义（P﹥0.05）。结论相比阿德福韦酯，替比夫定、恩替卡韦治疗慢性乙型肝炎整体疗效明显，且替比夫定相比恩替卡韦在保护患者肾功能上更有优势。

A Long-term Follow-up Study on Effect of Three Kinds of Nucleoside Analogues on Renal Function of Patients with Chronic Hepatitis B

Objective To investigate curative effect of Telbivudine,Entecavir and Adefovir Dipivoxil in treat-ment of chronic hepatitis B and their effects on renal function. Methods Chronic hepatitis B patients were respectively treated with Telbivudine( Telbivudine group,n = 40),Entecavir( Entecavir group,n = 40)and Adefovir Dipivoxil (Adefovir Dipivoxil group,n = 40)during January 2011 and January 2014,and all patients were intervened for 104 weeks. Clinical curative effect,adverse reactions and renal function indexes before and after treatment were compared in two groups. Results After 104 weeks of intervention,the negative conversion rate of HBV-DNA,serological conversion rate of hepatitis Be antigen(HBeAg)and total effective rate in Telbivudine group were significantly higher than those in Adefovir Dipivoxil group(P﹤0. 05). The negative conversion rate of HBV-DNA,normalization rate of Alanine Transar-ninase(ALT)and total effective rate in Entecavir group were significantly higher than those in Adefovir Dipivoxil group ( P﹤0. 05). After 104 weeks of intervention,serum creatinine levels were significantly lower than that in Adefovir Dipiv-oxil group,and the level in Telbivudine group was lower than that in Entecavir group(P﹤0. 05);estimated glomerular filtration rates were significantly higher in Telbivudine and Entecavir groups than that in Entecavir group,and the rate in Telbivudine group was higher than that in Entecavir group(P﹤0. 05). There were no significant differences in incidence rate of adverse reactions among three groups(P﹥0. 05). Conclusion The overall curative effects of Telbivudine and Entecavir in treatment of chronic hepatitis B are much better than that by Adefovir Dipivoxil,and Telbivudine has more advantages in protecting patientsˊ renal function compared with that by Entecavir.