阿德福韦酯长期应用对慢性乙型肝炎患者肾功能的影响

Effects of Long-term Use of Adefovir Dipivoxil on Renal Functions in Patients of Chronic Hepatitis B

【目的】探讨长期使用阿德福韦酯（ADV）治疗慢性乙型肝炎（CHB）对患者肾功能的影响。【方法】筛选出317例本院门诊单用或联用口服ADV（10mg／d）治疗24个月以上CHB患者，根据肾功能受损情况分为肾损伤组118例和非肾损伤组199例。整理分析近两年血清学、病毒学和肾功能检测结果，通过磐检验、二元logistics回归分析、ROC曲线分析等统计学方法探讨包括性别、年龄、ADV使用时间、ADV使用时联合使用其他抗病毒药物情况、HBsAg,HBeAg、HBV、DNA、ALT、GLU等因素对早期肾损伤情况的影响。【结果】砰检验表明：年龄和ADV用药时间结果有显著性差异，其余因素无显著性差异；二元logistics回归分析表明：年龄、ADV用药时间均对因变量是否早期肾损害存在显著性影响；ROC曲线分析表明：年龄和ADV用药时间均对早期肾损伤具有显著的敏感性，对应约登指数分别为0．616、0．422。【结论】年龄和ADV用药时间是早期肾损伤事件发生的危险因素，47．5岁可以作为早期肾损伤事件发生的临界参考年龄，ADV用药时间为3．175年可以作为早期肾损伤事件发生的临界参考年限。

[Objective]To investigate the effects of long-term use of adefovir dipivoxil （ADV） on renal functions in patients of chronic hepatitis B （CHB） .[Methods]A total of 317 patients with CHB who were treated with ADV （10 mg/d） alone or combined with oral administration of for more than 24 months were selected and divided into kidney injury group （118 cases）and non renal injury group （199 cases）according to the renal function damage.Serological, virological and renal function tests in the past two years were analyzed, By X2 test, Binary Logistic Regression Analysis, ROC curve analysis and other statistical methods , the effects of el- ements including the gender, age, time of use ADV, ADV combined with other antiviral drugs, HBsAg, HBeAg, HBV, DNA, ALT, GLU and other factors on early renal injury were accordingly investigated.[Results]Chi-square test showed that： there was significant difference in age and ADV medication time, but there was no significant difference between the other factors; Binary Logistics Regression Analysis showed that： age and ADV medication time had significant effect on the dependent variable of early renal damage; ROC curve a- nalysis showed that： age and ADV duration had a significant corresponding sensitivity on early renal injury , the relevant Youden＇s index was 0.616,0.422. [Conclusion] Age and treatment time of ADV are risk factors of renal damage incidents; the age of 47.5 years old can be used as a critical reference year of kidney damage events; the time of ADV medication is 3.175 years, which can be used as the critical reference life events of early renal injury occurred.