替比夫定联合阿德福韦酯治疗慢性乙型肝炎患者效果及其对肾功能的影响

Impact of combination telbivudine and adefovir dipivoxil on renal functions in the treatment of patients with chronic hepatitis B

目的探讨应用替比夫定(LDT)联合阿德福韦酯(ADV)治疗慢性乙型肝炎(CHB)患者的效果及其对肾功能的影响。方法2014年4月~2016年7月我院诊治的178例CHB患者,其中接受LDT治疗1年以上发生耐药者59例,接受ADV治疗1年以上发生耐药者59例和初始治疗的CHB患者60例,给予LDT联合ADV治疗,观察48 w。检测血清肌酐(Cr)水平,并计算估算的肾小球滤过率(eGFR)的变化。结果在治疗48 w末,初始治疗患者完全应答率为46.7%,显著高于LDT耐药组的28.8%或ADV耐药组27.1%,差异有统计学意义(P<0.05);治疗前,三组血清Cr和eGFR水平无统计学差异(P>0.05),在治疗48 w末,初始联合治疗患者血清Cr水平为(63.2±12.3)μmol/L,显著低于LDT耐药组患者的(71.2±14.3)μmol/L或ADV耐药组的(73.2±14.8)μmol/L(P<0.05),而eGFR为(111.4±16.1)ml·min-1·1.73m^2,显著高于LDT耐药组的(99.7±13.4)ml·min-1·1.73m^2或ADV耐药组的(99.3±13.1)ml·min-1·1.73m^2(P<0.05)。结论对于LDT或ADV治疗耐药的CHB患者采用LDT联合ADV继续治疗有效,或许能改善肾功能损伤,而初始联合治疗也值得进一步观察。

Objective To explore the impact of combination telbivudine(LDT)and adefovir dipivoxil(ADV)on renal functions in the treatment of patients with chronic hepatitis B.Methods 178 patients with CHB were recruited in our hospital between April 2014 and July 2016,and our patients with CHB included 59 patients with LDT resistant,59 with ADV resistant,and 60 naive.All patients received LDT and ADV combination therapy,and were followed-up for 48 weeks.The changes of serum creatinine(Cr)levels and estimated glomerular filtration rate(eGFR)were compared among the three groups.Results At the end of 48 weeks,the complete response rate in naive patients was 46.7%,significantly higher thant 28.8%in LDT resistant group or 27.1%in ADV resistant group(P<0.05);before treatment,serum Cr levels and eGFR in the three groups were not significantly different(P>0.05),while at the end of 48 weeks,serum Cr level in naive patients was(63.2±12.3)μmol/L,much lower than(71.2±14.3)μmol/L in LDT resistant or(73.2±14.8)μmol/L in ADV resistant group(P<0.05),and the eGFR was(111.4±16.1)ml·min-1·1.73m^2,significantly higher than(99.7±13.4)ml·min-1·1.73m^2 in LDT resistant or(99.3±13.1)ml·min-1·1.73m^2 in ADV resistant group(P<0.05).Conclusion Application of LDT and ADV combination is effective in the treatment of patients with chronic hepatitis B with resistant hepatitis B viral mutation infection,and the de novo combination of the two nucleosides might be in clinical trial for decreasing HBV mutation.