阿德福韦酯对慢性乙型肝炎老年患者的肾脏毒性分析

目的：探讨阿德福韦酯对老年慢性乙型肝炎（乙肝）患者的肾脏毒性。方法：收集2010至2015年收治的对拉米夫丁耐药的HBeAg阳性慢性乙肝患者138例，分为老年组68例和成年组70例，除给予拉米夫丁100 mg/d外，均加用阿德福韦酯10 mg/d治疗。治疗后分阶段进行血清学、病毒学和肾功能检测，观察治疗效果及药物对肾脏的影响。结果：两组治疗前、后的血清生化指标及病毒学指标比较差异均无统计学意义（P＞0.05），但治疗96周时，老年组肾功能异常累计发生率为16.18%（11/68），成年组为5.71%（4/70），组间差异有统计学意义（P＜0.05）。治疗24周时，老年组11例逐渐发生肾小球滤过率（eGFR）下降，减量阿德福韦酯后，eGFR水平上升，1例因eGFR持续下降而换药。结论：临床医师应对阿德福韦酯治疗老年慢性乙肝患者在第24周起开始密切监测肾功能变化，发生eGFR下降后减少阿德福韦酯每日用量可改善肾功能。

Analysis of adefovir dipivoxil on renal toxicity in the elderly patients with chronic hepatitis B

Objective:To study adefovir dipivoxil on renal toxicity in the elderly patients with chronic hepatitis B(CHB).Methods: A total of 138 cases of HBeAg positive CHB who resisted lamivudine in our hospital from 2010 to 2015 were collected and divided into an elderly group with 68 cases and an adult group with 70 cases. In addition to giving lamivudine 100 mg/d, adefovir dipivoxil 10 mg/d was given to all the patients. Serology, virology and kidney function inspections were performed in stages after treatment and treatment effects and inlfuence on kidneys were observed.Results:The comparative differences of serum biochemistry and virology indexes before and after treatment had no statistical signiifcance(P>0.05). After 96 weeks of treatment, the incidence of renal dysfunction in the elderly was 16.18%(11/68), the adult group was 5.71%(4/70), and the difference between the two groups had the statistical signiifcance(P<0.05). After 24 weeks of treatment, decrease of the estimated glomerular ifltration rate (eGFR) appeared in 11 cases of the elderly group and after reducing the dose of adefovir dipivoxil, the level of eGFR increased. One elderly patient changed medicine due to continuous decrease of eGFR.Conclusion:The clinician should closely monitor the kidney change of CHB patients treated with adefovir dipivoxil from the 24th week and reduce the daily dose of adefovir dipivoxil to change the kidney function after decrease of eGFR appears.