阿德福韦酯经治患者加用替比夫定的疗效观察及肾脏功能评价

Effect of adding on telbivudine or switching to telbivudine alone on therapeutic efficacy and renal function in chronic hepatitis B patients on adefovir dipivoxil monotherapy

目的探讨阿德福韦酯(adefovir dipivoxil,ADV)经治的慢性乙型肝炎(chronic hepatitis B,CHB)患者加用替比夫定(telbivudine,L-DT)后乙型肝炎e抗原(hepatitis B e antigen,HBeAg)血清转换率,并对肾脏功能进行评价.方法回顾性分析2013-1/2016-12应用ADV(10 mg/d)单药治疗的HBeAg阴性CHB患者42例,其中加用L-D T治疗的20例患者定义为联合组,22例换用恩替卡韦(entecavir,ETV)治疗者定义为单药组,分别在24 wk、48 wk时分析两组数据的HBeAg血清学转换率,并采用国际公认的肾脏病膳食改良试验(Modification of Diet in Renal Disease,MDRD)公式来计算两组的肾小球滤过率估计值[estimated glomerular filtration rate,eGFR=186×血清肌酐水平^(–1.154)×年龄^(–0.203)×1.21(黑人)]×[0.742(女性)],对两组肾脏功能进行评估.结果分别统计两组24 wk和48 wk的eG FR,联合组的eG FR平均水平较单药组有所改善,独立样本t检验后,发现24 wk和48 wk对应的P值分别为0.773和0.108,差异无统计学意义,同时将两组48 wk时的eGFR分别与基线对比,联合组t值为-6.184,P<0.05,差异有统计学意义,单药组t值为-0.893,P>0.05,差异无统计学意义;对24 wk和48 wk不同组别患者HBeAg血清转换率进行比较,P值分别为0.043和0.034,联合组的HBeAg血清转换率优于单药组.结论对于ADV经治的HBeAg阴性CHB患者,联合应用L-DT,可获得较高的HBeAg血清学转换,长期治疗可改善肾脏功能.

AIM To explore the serum conversion rate of hepatitis B eantigen （HBeAg） and renal function in patients with chronic hepatitis B （CHB） treated with aldefovir dipivoxil （ADV） plus telbivudine （L-DT）. METHODS This retrospective cohort study included 42 patients with HBeAg-negative CHB who were on ADV （10 mg） monotherapy. Twenty patients were treated with L-DT add-on therapy （combination therapy group）, and 22 patients were switched to ETV monotherapy （monotherapy group）. At 24 and 48 wk, the conversion rate of HBeAg and renal function evaluated by estimated glomerular filtration rate （eGFR） were analyzed and compared between the two groups. RESULTS The eGFR at 24 and 48 wk did not differ significantly between the two groups （P = 0.773, 0.108）. The eGFR in the combination therapy group was significantly higher at 48 wk than at baseline （t = -6.184, P 〈 0.05）, but no significant difference was observed in the monotherapy group （t = -0.893, P 〉 0.05）. The serum conversion rates of HBeAg at 24 wk and 48 wk were significantly higher in the combination therapy group than in the monotherapy group （P = 0.043, 0.034）. L-DT based treatment is effective in elevating the serum conversion rate of HBeAg, and long-term therapy is associated with sustained improvement of renal function, particularly among HBeAg-negative CHB patients treated with ADV.