慢性乙型肝炎病毒感染者合并慢性肾脏病患病率及影响因素

Prevalence and influencing factors of chronic hepatitis B virus infection complicated with chronic kidney disease

目的研究慢性乙型肝炎病毒(HBV)感染者合并慢性肾脏病患病率及影响因素。方法选取2016年7月至2017年7月于首都医科大学附属地坛医院就诊的慢性HBV感染者,根据研究对象的血清肌酐(Scr)水平、年龄、性别应用简化肾脏病饮食调整工作组(MDRD)方程计算目标人群的肾小球滤过率(eGFR),评估目标人群合并慢性肾脏病情况,同时分析影响患病率的危险因素。结果本研究共收集6 665例慢性HBV感染者,其中男性4 457例,女性2 208例;HBV携带者607例,慢性乙型病毒性肝炎患者4 630例,乙型肝炎后肝硬化患者1 428例。合并慢性肾脏病(CKD)患病率:eGFR <60 ml/min/1.73 m2患者72例(1.08%),60 ml/min/1.73 m2≤eGFR <90 ml/min/1.73 m2患者586例(8.79%),男性患者患病率高于女性,但差异无统计学意义(χ~2=0.52、P=0.473)。随着年龄增长,CKD患病率增加,不同年龄段患者患病率差异有统计学意义(χ~2=356.71、P <0.001)。肝硬化患者合并CKD患病率(3.15%)显著高于HBV携带者(0.16%)及慢性乙型肝炎患者(0.59%),差异有统计学意义(χ~2=144.00、P <0.001)。结论慢性HBV感染者随着疾病进展,慢性肾脏病患病率增加,高龄、肝硬化、高血压、糖尿病均为慢性HBV感染者发生CKD的独立危险因素。

Objective To investigate the prevalence and influencing factors of chronic hepatitis B virus (HBV)infection complicated with chronic kidney disease.Methods From July 2016 to July 2017,the patients with chronic HBV infection were selected from Beijing Ditan Hospital,Capital Medical University.According to the serum creatinine (Scr)level and age of the subjects,the MDRD-equation was used to calculate the glomerular filtration rate (GFR)of the patients,and the prevalence rate of chronic kidney disease in the target population was estimated and the risk factors affecting the prevalence were analyzed.Results Total of 6665 patients with chronic HBV infection were collected,including 4457 males and 2208 females;607HBV carriers,4630 patients with chronic hepatitis B and 1428patients with liver cirrhosis after hepatitis B.The prevalence rate of chronic kidney disease (CKD)in patients with eGFR<60ml/min/1.73m^2 and 60≤eGFR <90ml/min/1.73m^2 were 72cases (1.08%)and 586cases (8.79%),respectively,which was higher of male patients than that of women,but with no significant differences (X^2=0.52,P =0.473).The prevalence of CKD increased with age increasing and the difference was significant among patients with different ages (X^2=356.71,P <0.001).The prevalence rate of CKD in patients with cirrhosis (3.15%)was significantly higher than that in patients of HBV carrier (0.16%)and chronic hepatitis B (0.59%),with significant difference (X^2=144.00,P <0.001).Conclusions Chronic HBV infection is associated with disease progression and CKD prevalence.Age,cirrhosis,hypertension and diabetes are all independent risk factors for CKD in patients with chronic HBV infection.