恩替卡韦联合免疫抑制剂治疗乙肝病毒相关性肾小球肾炎的效果

Effects of entecavir combined with immunosuppressant in treatment of hepatitis B virus-associated glomerulonephritis

目的:观察恩替卡韦(ETV)联合免疫抑制剂治疗乙肝病毒相关性肾小球肾炎(HBV-GN)的临床疗效。方法:回顾性分析86例HBV-GN患者(免疫抑制剂治疗28例,甲泼尼龙片4~48 mg/d;ETV抗病毒治疗28例,ETV 0.5 mg,1次/d;ETV联合免疫抑制剂治疗30例,同时给予甲泼尼龙片和ETV治疗,剂量同上)的资料,治疗前及治疗6个月后测定血清生化指标[谷丙转氨酶(ALT)、白蛋白(ALB)、尿素氮(BUN)、肌酐(Scr)]、24 h尿蛋白(双缩脲法)及HBV-DNA定量水平(荧光定量PCR法),并分析HBV-DNA阴转率和总有效率。结果:除免疫抑制剂组ALT外,3组患者治疗后ALT、BUN、Scr、24 h尿蛋白水平均降低,ALB水平升高;与免疫抑制剂组比较,ETV组ALB水平升高和Scr水平降低更显著,ETV联合免疫抑制剂组ALB水平升高和BUN水平降低更显著(P<0.05)。与免疫抑制剂组比较,ETV组和ETV联合免疫抑制剂组HBV-DNA阴转率均提高(P<0.001)。3组患者的总有效率比较差异有统计学意义,且ETV联合免疫抑制剂组高于ETV组,ETV组高于免疫抑制剂组(P<0.001)。结论:ETV和免疫抑制剂联合治疗可作为HBV-GN患者临床治疗的首选方案。

Aim:To observe the clinical efficacy of entecavir(ETV)combined with immunosuppressant in the treatment of hepatitis B virus-associated glomerulonephritis(HBV-GN).Methods:A retrospective study was performed to analyze 86 cases of HBV-GN treated with 3 different methods,28 cases were treated with immunosuppressant,methylprednisolone 4-48 mg/d,28 cases were treated with ETV at 0.5 mg/d,and 30 cases were treated with ETV combined with immunosuppressant(methylprednisolone),same dose as above.The biochemical indexes(ALT,ALB,BUN,Scr),24 hours urine protein(biuret method)and HBV-DNA quantitative level(fluorescence quantitative PCR)were determined before and after 6 months.Results:Except the ALT of the immunosuppressant group,the levels of ALT,BUN,Scr and 24 hours urine protein in 3 groups were all decreased and ALB was increased(P<0.05).Compared with the immunosuppressant group,ALB increased and Scr decreased significantly in ETV group and the combined group,especially the combined group(P<0.05).Compared with the immunosuppressant group,the negative rates of HBV-DNA in ETV group and combined group significantly increased(P<0.001).The total effective rates of the 3 groups were significantly different,the total effective rate of combined group was higher than that of the ETV group,and the ETV group was higher than that of the immunosuppressant group(P<0.001).Conclusion:The combination of ETV and immunosuppressant could be the first choice of clinical treatment for HBV-GN patients.