替比夫定与恩替卡韦对阿德福韦酯相关肾损害的慢性乙型肝炎患者肾功能改善效果比较及其影响因素

目的 比较替比夫定(LdT)与恩替卡韦(ETV)对阿德福韦酯(ADV)相关肾损害的慢性乙型肝炎(CHB)患者肾功能的改善效果并探讨其影响因素.方法 阿德福韦酯相关肾损害的CHB或乙型肝炎肝硬化患者41例,分为LAT组(n=21)和ETV组(n=20),停阿德福韦酯后分别给予替比夫定和恩替卡韦抗病毒治疗,疗程均为24周.比较两组治疗前后肾功能的变化情况,并分析其影响因素.结果 两组基线估算肾小球滤过率(eGFR)比较差异无统计学意义(P＞0.05),治疗24周后两组eGFR较治疗前均有改善,且LdT组改善程度优于ETV组(P均＜0.05).多因素logistic回归分析结果显示,基线eGFR＜ 60 ml·min-1·1.73 m-2和LdT方案是肾功能改善的影响因素(P均＜0.05).结论 替比夫定对阿德福韦酯相关肾损害的CHB肾功能改善效果更为明显,且对于基线eGFR＜ 60 ml·min-·1.73 m-2的患者其改善效果更好.

Efficacy comparison between telbivudine and entecavir on renal function recovery in chronic hepatitis B patients with adefovir dipivoxil-associated renal damage and its influence factors

Objective To compare the clinical efficacy between telbivudine(LdT) and entecavir(ETV) on renal function recovery in chronic hepatitis B (CHB) patients with adefovir dipivoxil (ADV)-associated renal damage,and to investigate its influence factors.Methods A total of 41 CHB or liver cirrhosis due to hepatitis B patients with ADV-associated renal damage were divided into LdT group (n =21) and ETV group(n =20).The two groups were given LdT and ETV respectively after ADV withdrawal,and the treatment lasted for 24 weeks.The baseline and the variation of renal function after treatment were compared between the two groups,and the influence factors were analyzed.Results There was no significant difference in estimated glomerular filtration rate(eGFR) between the two groups at baseline(P ＞ 0.05),but the eGFRs were improved distinctly after 24 weeks of treatment in both groups compared to those before treatment,and the extent of eGFR improvement was more significant in LdT group than that in ETV group (all P ＜ 0.05).The multivariate logistic regression analysis showed that the baseline eGFR ＜60 ml · min-1 · 1.73 m-2 and LdT regimen were the influence factors of renal function recovery(all P ＜0.05).Conclusion LdT has more significant effects on renal function recovery in CHB patients with ADV-associated renal damage,especially for the patients whose baseline eGFRs are less than 60 ml · min-1 · 1.73 m-2.