替诺福韦酯与恩替卡韦治疗慢性乙型肝炎肾安全性Meta分析

目的:通过系统综述和Meta分析比较替诺福韦酯（TDF）与恩替卡韦（ETV）治疗慢性乙型肝炎（CHB）时，对肾功能包括肾小球滤过率（eGFR）、血肌酐(creatinine)、血磷酸盐（phosphate）的影响。方法:计算机检索PubMed、EMbase、Springer、Cochrane Library、中国期刊全文数据库、万方数据库2018年6月之前的有关TDF和ETV治疗CHB患者相关文献。按照NOS评分标准，评价纳入文章质量，采用Stata12.0进行Meta分析。结果:共纳入相关文献9篇，包括2 346例患者。Meta分析结果显示TDF和ETV在治疗CHB患者24月时，eGFR、血肌酐、血磷的SMD分别为-0.07（95%CI:-0.31~0.16），-0.15（95%CI:-0.46~0.17），-0.37（95%CI:-0.66~-0.08），组间效应24月时eGFR、血肌酐、血磷的影响分别是（t=2.48，P=0.056），（t=-1.98，P=0.105），（t=1.41，P=0.252）。结论:TDF和ETV在CHB患者治疗时，均影响肾功能，对eGFR、血肌酐、血磷的影响均无显著性差异。TDF和ETV治疗慢性乙型肝炎患者的肾安全有相似性。

A meta-analysis on renal safety of tenofovirdisoproxil and entecavir in patients with chronic hepatitis B

Objective: To compare the effects on renal function including glomerular filtration rate（eGFR）, serumcreatinine and serum phosphate of tenofovirdisoproxil（TDF） and entecavir（ETV） in patients with chronic hepatitis B（CHB）. Methods: Various controlled study data before June 2018 through computer research were retrieved from PubMed, EMbase, Springer, Cochrane Library, CNKI, WanFang database for TDF and TEV effect on renal function when treating CHB patients. The quality of the included articles were assessed according to the NOS score criteria and the related meta-analysis was performed. Results: A total of 9 articles were included in the meta-analysis. The results of meta-analysis showed that the effects of TDF and ETV on eGFR, serum creatinine and serum phosphorus were respectively SMD-0.07（95% CI: -0.31~0.16）; -0.15（95% CI: -0.46~0.17）;-0.37(95% CI: -0.66 ~ -0.08). The effects of intergroup on eGFR, serum creatinine and serum phosphorus were respectively(t =2.48,P= 0.056) ;(t= 1.98, P= 0.105);（t=1.41, P=0.252） in the treatment of CHB patients in 24 months. There was a similarity between TDF and ETV for renal safety in patients with CHB. Conclusion: Both TDF and ETV may affect the renal function of the patients with CHB. There may be no significant differences between the effects on eGFR, serum creatinine, serum phosphorus when treated with such two drugs.