长期应用阿德福韦酯慢性乙型肝炎患者肾脏损害的临床研究

Clinical study of adefovir dipivoxil in renal impairment

回顾性分析127例使用阿德福韦酯（ADV）治疗的慢性乙型肝炎（CHB）患者发生肾损害的发生率及肾脏病理改变.治疗12个月时,2例（1.6%）发生肾损害,24个月肾脏损害发生率为7.1%（9例）,其中7例仅表现为尿常规的改变和/或肾小球滤过率（eGFR）的轻度下降,2例患者出现中度的eGFR的下降,未发现重度肾脏损害的患者.36个月时,13例发生肾损害,其中10例为轻度,2例为中度,1例合并高血压的患者出现重度肾损害,并合并骨痛等改变.低磷血症发生率为3.9%（5/127）.2例诊断为Fanconi综合征合并低磷性骨软化症,病理结果为轻到中度肾小管病变.对中重度肾损害患者进行治疗药物调整,所有患者肾功能稳定,无进行性加重.

To elucidate the incidence of renal impairment in chronic hepatitis B （CHB） patients on adefovir dipivoxil （ADV）. We retrospectively enrolled 127 CHB patients on ADV alone （38.6%） or in combination with lamivudiue （61.4%） for over 12 months. Renal function was measured by estimated glomerular filtration rate （eGFR）. And renal dysfunction was defined as mild （ 〈 30% decrease） , moderate （30% - 50% ） or severe （ 〉 50% ） . During a treatment duration of 12 months, 2 patients （ 1.6% ） developed mild renal impairment. At Month 36 ,there were 13 patients with renal damage （ 10. 4% ） and one case of hypertension with severe renal impairment plus bone pain. The characteristic of renal pathology was tubule injury. Modification of dosing interval or discontinuation of ADV may arrest a further decline of eGFR in CHB patients.