替比夫定联合阿德福韦酯治疗慢性乙型肝炎患者血清eGFR 的动态变化

目的 评价替比夫定（L-DT）联合阿德福韦酯（ADV）单药治疗慢性乙型肝炎（CHB）对肾脏功能的影响,明确L-DT 是否具有改善肾小球滤过率的作用。方法 回顾性分析应用L-DT 及ADV 单药治疗的118 例CHB 患者治疗基线、治疗24 和52 周时肾小球滤过率（eGFR）的动态变化,比较两组患者中肾功能受损eGFR<90 ml/（min·1.73 m2）患者的比例。结果 治疗52 周时与基线相比,替比夫定组CR 降低,eGFR 升高（P <0.05）;阿德福韦酯组CR 升高,eGFR 降低（P <0.05）。治疗前后均未观察到CR 高于正常值上限（ULN）或较基线升高>0.50 mg/dl 患者;L-DT 组中,以eGFR 衡量的肾功能受损患者的构成比,由基线时的20.90% 降至52 周时的5.97%,而ADV 组则由19.61% 升至23.53%。两组在基线时比较差异无统计学意义（P >0.05）,治疗52 周时差异有统计学意义（P <0.05）。结论 应用替比夫定抗病毒治疗,能够提高血清eGFR,改善肾脏功能,而应用ADV 治疗则需早期警惕血清eGFR 的下降,及时进行治疗方案的调整。

Influence of Telbivudine or Adefovir Dipivoxil monotherapy on eGFR of patients with chronic hepatitis B

Objective To investigate the changes in the renal function of the patients with chronic hepatitis B(CHB) receiving Telbivudine (L-DT) or Adefovir (ADV) monotherapy, and determine whether L-DT has the effectof increasing the estimated glomerular filtration rate (eGFR). Methods A retrospective analysis was made for 118CHB patients receiving either L-DT (n = 67) or ADV (n = 51) monotherapy for 52 weeks. The dynamic changesof eGFR on baseline, in the 24th and 52nd weeks of treatment were analyzed. The proportions of the patients withimpaired renal function (eGFR <90 ml/min.1.73 m2) were compared between both groups. Results Compared to thebaseline levels, CR decreased and eGFR increased significantly in the L-DT group after 52 weeks of treatment (P <0.05), while CR increased and eGFR decreased significantly in the ADV group (P < 0.05). No patient was found tohave CR higher than the upper limit of normal level (ULN) or an elevation of CR over 0.50 mg/dl before and aftertreatment. In the L-DT group the proportion of the patients with impaired renal function (based on eGFR) decreasedfrom 20.90% at baseline to 5.97% at the 52th week, while that in the ADV group increased from 19.61% to 23.53%.The proportion of the patients with impaired renal function had no statistical difference at baseline (P > 0.05), but had statistical difference at week 52 (P < 0.05) between the two groups. Conclusions L-DT antiviral therapy can increase eGFR and improve the renal function. However, when using ADV therapy, the decrease of serum eGFR should be paid attention in early stage, and the therapy should be adjusted timely.