不同程度慢性乙型肝炎患者肾功能评估及危险因素分析

目的 对不同程度慢性乙型肝炎（CHB）患者肾功能进行评估，分析正规抗病毒治疗对CHB患者肾功能的影响，分析CHB患者肾功能损伤的危险因素。方法 收集2015年1月至2016年4月于安徽医科大学第一附属医院379例CHB患者，按照CHB临床分度将患者分为轻度组（191例）、中度组（123例）、重度组（65例）3组，采用简化MDRD方程计算CHB患者肾小球滤过率（eGFR）。分析不同程度CHB患者肾功能有无差异，正规抗病毒治疗对不同程度CHB患者肾功能的影响及年龄、性别、HBeAg、HBV DNA等对CHB患者肾功能的影响。结果 轻度组患者eGFR水平为（73.10±14.42）mL/（min·1.73m²），中度组患者eGFR水平为（65.17±11.42）mL/（min·1.73m²），重度组患者eGFR水平为（59.72±18.59）mL/（min·1.73m²），3组间eGFR水平差异具有统计学意义（F=25.200，P=0.000）；CHB患者肝炎病情程度和年龄是引起CHB患者出现肾功能损伤的危险因素（P<0.05）。结论 CHB患者eGFR水平与病情程度相关，轻度和中度正规抗病毒治疗的CHB患者eGFR水平较未正规抗病毒治疗者eGFR水平高，肝炎病情程度与年龄是引起CHB患者出现肾功能损伤的危险因素。

Evaluation of renal function and risk factors in patients with chronic hepatitis B

Objective To evaluate renal function in patients with different degrees of chronic hepatitis B, and to analyze the effect of antiviral therapy on renal function of chronic hepatitis B patients and other influencing factors. Methods We collected the data of 379 chronic hepatitis B patients hospitalized in the First Affiliated Hospital of Anhui Medical University from Jan2015 to April 2016, and according to the clinical classification of chronic hepatitis B, the cases were divided into three groups:mild(191), moderate(123), severe(65). The glomerular filtration rate was calculated using the simplified MDRD equation.It was analyzed whether there were differences in renal function in patients with different degrees of chronic hepatitis B,and whether regular antiviral therapy had an effect on renal function in patients with different degrees of chronic hepatitis B,and whether age,gender,e antigen,hepatitis B virus load could lead to renal injury.Results Among 379 cases of chronic hepatitis B patients with mild, moderate and severedegree, the eGFR levels were(73.10±14.42) mL/(min·1.73m²),(5.17±11.42) mL/(min·1.73m²), (59.72±18.59) mL/(min·1.73m²), respectively. In the three groups, there were significant differences between every two groups (F=25.200, P=0.000), and the difference between every two groups was statistically significant.The severity and age of hepatitis in CHB patients were risk factors for renal dysfunction. Conclusion The level of eGFR in patients with CHB is correlated with the severity of the disease, andthe levels of eGFR in mild and moderate CHB patients with antiviral therapy are higher than those without antiviral therapy.Disease severity and age are risk factors for renal dysfunction in patients with CHB.