醋酸泼尼松联合恩替卡韦治疗乙肝病毒相关性肾炎的疗效观察

Prednisone combined with entecavir for the treatment of hepatitis B virus associated glomerulonephritis

目的观察醋酸泼尼松联合恩替卡韦治疗乙型肝炎病毒相关性肾炎(HBV-GN)的疗效。方法回顾性分析2000年1月至2012年1月我院确诊的20例HBV-GN且达到肾病综合征诊断标准的患者,给予醋酸泼尼松1 mg/(kg·d)联合恩替卡韦0.5 mg/d治疗6个月,分别于治疗1、3、6个月后复查24 h尿蛋白定量、血清白蛋白、肝肾功能、HBV-DNA定量、HBeAg转阴率。结果治疗6个月后蛋白尿完全缓解9例,部分缓解8例,无效3例,总有效率85%,其中5例HBV-DNA转阴,4例HBeAg转阴,所有患者HBV-DNA定量均不同程度下降。所有患者治疗后未出现明显肝肾功能损害、病毒复制增加。结论醋酸泼尼松联合恩替卡韦治疗表现为肾病综合征的HBV-GN安全有效,可以有效降低24 h尿蛋白定量,提高血清白蛋白,降低乙肝病毒复制。

Objective To investigate the efficacy and safety of prednisone combined with entecavir for the treatment of hepatitis B virus associated glomerulonephritis（HBV-GN）.Methods 20 patients with HBV-GN of our hospital from Jan 2000 to Jan 2012 were treated by prednisone combined with entecavir.The initial dosage of prednisone[1.0 mg /（kg·d） ]was used at the beginning and combined with entecavir at the dosage of 0.5 mg/d.The duration of the treatment was six months.Regular test was conducted after 1,3,6 month.Results Of all cases,9 patients＇ urinary protein had fully remission,8 cases had partial remission,3 cases had no efficiency,5 cases＇ HBV-DNA and 4cases＇ HBeAg had become negative,all cases got reduced.Renal and liver function remained stable.Conclusion Prednisone combined with entecavir is an effective and safe method for HBV-GN,it can reduce 24-hour urinary protein,raise serum albumin,stabilize kidney and liver function,and reduce hepatitis B virus DNA.