阿德福韦酯和替比夫定单药治疗慢性乙型肝炎对肾脏功能影响的比较

nfluence of adefovir dipivoxil or telbivudine monotherapy on renal function of patients with chronic hepatitis B

目的比较阿德福韦酯(ADV)及替比夫定(L-DT)单药治疗慢性乙型肝炎和肝硬化患者对肾脏功能的影响。方法回顾性分析接受ADV(n=46)及L-DT(n=55)单药治疗的101名慢性乙型肝炎和肝硬化患者,比较治疗52周的血清肌酐(CR)、估算肾小球滤过率(eGFR)较基线的变化情况及eGFR≥90 ml.min-.11.73 m-2患者的比例。结果 52周时,ADV和L-DT组患者CR较基线变化平均值分别为+0.05和-0.12 mg/dl(ADV vs L-DT,P=0.000),未观察到CR较基线升高>0.50 mg/dl患者;eGFR较基线变化中位数分别为-4.09和+18.32 ml.min-.11.73 m-(2ADV vs L-DT,P=0.000);基线肾功能轻度受损(eGFR<90 ml.min-.11.73 m-2)的患者中,ADV组有37.50%(3/8)在52周时上升至大于90 ml.min-1.1.73 m-2,L-DT组有92.31%(12/13)上升至大于90 ml.min-.11.73 m-2;ADV组eGFR≥90 ml.min-.11.73 m-2患者比例由基线的82.61%降至52周的78.26%,而L-DT组eGFR≥90 ml.min-1.1.73 m-2患者比例由基线的76.36%升至52周的94.55%;两组不同eGFR水平患者的构成比在基线时无统计学差异(P=0.443),52周时有统计学差异(P=0.015)。结论 L-DT抗病毒治疗对于肾脏功能具有一定的保护作用,但具体机制不明,需要进一步研究。

Objective To evaluate the changes in the renal function of patients with chronic hepatitis B （CHB） receiving adefovir dipivoxil （ADV） or telbivudine （L-DT） monotherapy. Methods This retrospective analysis involved 101 patients with CHB and liver cirrhosis receiving either ADV or L-DT monotherapy for 52 weeks. Serum creatinine, estimates of glomerular filtration rate （eGFR）, and the percentage of patients with eGFR≥90 ml. min1.1.73 m2 at week 52 were compared with the baseline data between the two groups. Results The mean changes of CR at week 52 from baseline were ＋0.05 mg/dl in ADV group and -0.12 mg/dl in L-DT group, showing a significant difference between the two groups （P=0.000）. No patient was found to have an elevation of creatinine over 0.50 mg/dl. The median change of eGFR at week 52 from baseline differed significantly between ADV and L-DT groups （-4.09 vs＋18.32 ml- min-1. 1.73 m^2, P=0.000）. Ninety-two percent （12/13） of the patients with baseline eGFR〈90 ml. min-1.1.73 m^2 shifted to eGFR ≥90 ml. min-1.1.73 m^-2 after 52 weeks of L-DT treatment, as compared to 38% （3/8） in ADV group. The proportion of patients with eGFR≥90 ml. min^-1. 1.73 m2 in L-DT group increased from 76.36% （42/55） at baseline to 94.55% （52/55） at week 52, while that in ADV group decreased from 82.61% （38/46） at baseline to 78.26% （36/46）. The constituent ratios of eGFR at different levels were similar at baseline （P=0.443） but significantly different at week 52 between the two groups （P=0.015）. Conclusion L-DT treatment is associated with a renoprotective effect in patients with CHB, but the mechanism remains unclear.