肾炎合并乙型肝炎病毒感染患者激素与抗病毒药物的联合应用价值

Joint application of hormones and antiviral drugs in the treatment of nephritis combined with hepatitis B virus infection

目的对肾炎合并乙型肝炎病毒感染患者进行激素与抗病毒药物联合治疗,研究在该类疾病中的应用价值。方法选取在我院住院治疗的非乙型肝炎病毒携带的肾炎患者40例为对照组,给予甲基强的松龙40 mg/d,1周后改为强的松1 mg/(kg.d),后按照肾炎治疗标准减量。肾炎合并乙型肝炎患者45例为治疗组,加用拉米夫定100 mg/d治疗。对所有患者治疗前后HBV DNA、肝肾功能、血尿常规进行测定。结果治疗组HBV DNA阴性者治疗后仍阴性;HBV DNA(滴度102～103)者治疗后41.2%转阴,52.9%滴度下降,5.9%滴度先下降后又上升;HBV DNA(滴度104～105)者治疗后33.3%转阴性,33.3%滴度下降,33.3%先下降后上升;HBV DNA(滴度106～107)者100%滴度下降。对照组治疗前后谷丙转氨酶、谷草转氨酶水平比较差异无统计学意义(P>0.05);治疗组治疗前后谷丙转氨酶、谷草转氨酶水平比较差异亦无统计学意义(P>0.05)。对照组与治疗组药物治疗后,肾炎治疗疗效比较,对照组完全缓解率为55.0%,总有效率为80.0%;治疗组完全缓解率为57.8%,总有效率为86.7%。两组比较差异均无统计学意义(P>0.05)。结论激素联合抗病毒药物拉米夫定治疗肾炎合并乙肝病毒感染的患者安全有效,HBV DNA及肝功能影响小,临床缓解率与非乙肝病毒感染的肾炎患者相当。

Objective To explore the clinical value of the joint application of hormones and antiviral drugs in the treatment of nephritis combined with hepatitis B virus infection. Methods 40 cases of nephritis combined with non-hepatitis-B virus infection were chosen as the control group. Patients in the control group were given Methylprednisolone 40 mg/d and were changed to prednisone 1 mg/（kg＇d） one week later and the dose were then reduced gradually in accordance with nephritis treatment standards. 45 cases of nephritis combined with hepatitis B were chosen as treatment group and were given Lamivudine 100 mg/d in addition to the treatment given in the control group. HBV DNA, liver and kidney function and urinalysis of all the patients were determined before and after treatment. Results HBV DNA negative in the treatment group was still negative after treatment; 41.2% of HBV DNA （titer 102-10s） turned negative after treatment, 52.9% declined in titer and 5.9% first declined＇ and then rose in titer; HBV DNA in （titer 104-105） after treatment, 33.3% negative, 33.3% decline in titer, rose 33.3% decline; 100% of HBV DNA （titer 106-107） declined in titer. Alanine aminotransferase and as- partate aminotransferase level of the control group were not significantly different before and after treatment （P 〉 0.05） and so were in the treatment group （P 〉 0.05）. In terms of nephritis therapeutic efficacy, in the control group, the complete re- mission rate was 55.0% and total effective rate was 80.0%, while in the treatment group, the complete remission rate of 57.8% and total effective rate was 86.7%. The treatment outcomes were not significantly different between the two groups （P 〉 0.05）. Conclusion Joint treatment of hormone and antiviral drug is effective and safe in the treatment of nephritis combined with hepatitis B virus infection, and has little effect on HBV DNA and liver function. It has comparable clinical remission rate as in the treatment of neuhritis combined with non-hepatitis B virus infection.