替诺福韦和恩替卡韦对老年慢性乙肝病人的抗病毒疗效及对肾功能的影响

Antiviral efficacy of tenofovir and entecavir in elderly patients with chronic hepatitis B and its effect on renal function

目的比较替诺福韦(TDF)与恩替卡韦(ETV)单药治疗老年慢性乙型肝炎(CHB)病人的抗病毒疗效及治疗过程中对肾功能的影响。方法回顾性分析2014~2018年在我院诊治的50例CHB病人的临床资料,其中22例服用TDF,28例服用ETV。收集病人在治疗过程中的病毒学应答、血清肌酐(serum creatitine,SCr)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、血清中的视黄醇结合蛋白(retinol-binding protein,RBP)和β2-微球蛋白(β2-microglobulin,β2-MG)等指标的变化情况。比较2组病人的抗病毒疗效及药物对肾功能的影响。结果2组均出现较好的病毒学应答,且24个月内未见病毒学突破。治疗过程中2组各时点HBV DNA阴转率比较,差异均无统计学意义(P>0.05)。治疗过程中,2组各时点的SCr、eGFR水平差异均无统计学意义(P>0.05);治疗18、24个月时,TDF组的β2-MG水平明显高于ETV组,差异有统计学意义(P<0.05);治疗24个月时,TDF组的RBP水平明显高于ETV组,差异有统计学意义(P<0.05)。结论对于老年CHB病人,ETV和TDF均有较好的抗病毒疗效,但在使用TDF过程中需要定期评估肾功能,对肾功能的评估除SCr、eGFR外,还需要重视RBP和β2-MG。

Objective To compare the antiviral efficacy of tenofovir(TDF)and entecavir(ETV)in the elderly patients with chronic hepatitis B(CHB)and the effect on renal function during the treatment.Methods Clinical data of 50 CHB patients treated in our hospital from 2014 to 2018 were retrospectively analyzed,with 22 cases of taking TDF and 28 cases of taking ETV.The levels of HBV DNA,serum creatitine(SCr),estimated glomerular filtration rate(eGFR),retinol-binding protein(RBP)and β2-microglobulin(β2-MG)in serum were measured periodically during the treatment.The antiviral efficacy and the renal function were compared between the two groups.Results Both groups showed good virological response and no virological breakthrough within 24 months.During the treatment,there was no significant difference in the negative rate of HBV DNA and the levels of SCr and eGFR between the two groups(P>0.05);18 and 24 months after treatment,the level of β2-MG in TDF group was significantly higher than that in ETV group(P<0.05);24 months after treatment,the level of RBP in TDF group was significantly higher than that in ETV group(P<0.05).Conclusions TDF and ETV have good antiviral efficacy in elderly patients with CHB,but renal function needs to be evaluated regularly during the use of TDF.In addition to SCr and eGFR,RBP and β2-MG should also be emphasized in the evaluation of renal function.