长期应用阿德福韦酯抗病毒方案对慢性乙型肝炎患者肾功能的影响及其危险因素分析

Impact and risk factors of long-term antivirus therapy with adefovir dipivoxil on renal function in patients with chronic hepatitis B

目的观察应用阿德福韦酯(ADV)抗病毒方案治疗慢性乙型肝炎(CHB)时对肾功能的影响,并分析影响ADV致肾功能衰减的危险因素。方法接受ADV单药或者ADV联合恩替卡韦/拉米夫定(ETV/LAM)治疗的40例CHB或CHB后肝硬化患者,观察治疗前、治疗1年、治疗2年、治疗3年时估算肾小球滤过率(eGFR)、累积肾功能衰减率的变化情况,并采用Cox回归模型分析影响肾功能衰减的因素。结果与基线对比,治疗2年、3年时eGFR下降(P均<0.05),治疗3年时eGFR更低(P<0.05),治疗1、2、3年时肾功能异常构成比与基线比较,差异均有统计学意义(P<0.05),治疗1、2、3年时的累积肾功能衰减率分别为2.53%、5.06%、12.86%。多因素分析显示,开始服用ADV的年龄≥50岁是肾功能衰减的独立危险因素(P<0.05)。结论长期应用含ADV的抗病毒方案可引起肾功能损害,开始服用ADV时年龄≥50岁是ADV引起肾功能衰减的独立危险因素。

Objective To observe the impact of adefovir dipivoxil（ADV） on the renal function of patients with chronic hepatitis B （CHB） , and to analyze the risk factors influencing renal insufficiency due to ADV. Methods The change of estimated glomerular filtration rate （eGFR） and cumulative renal insufficiency rate before treatment （the baseline）, after one,two and three years of treatment were observed among 40 patients with CHB or liver cirrhosis due to CHB receiving ADV alone or ADV plus entecavir（ ETV）/lamivudine（LAM）. The Cox regression model analysis was performed for the factors which might influence renal insufficiency. Results Compared with the baseline, eGFRs after two and three years of treatment decreased significantly （ all P 〈 0.05 ）, especially at three years after treatment （ P 〈 0.05 ）. The proportions of abnormal renal function at one, two and three years after treatment were significantly different with the baseline （P 〈 0.05 ）. The cumulative rates of renal insufficiency at one, two and three years after treatment were 2.53% ,5.06% and 12.86%, respectively. The multivariate analysis showed that age for starting ADV treatment ≥50 years was the independent risk factor for renal insufficiency（ P 〈 O. 05 ）. Conclusion Long-term antivirus therapy with ADV might lead to renal impairment,and age for starting ADV treatment i〉50 years is the independent risk factor for ADV-induced renal insufficiency.