他克莫司联合小剂量糖皮质激素和恩替卡韦对HBV相关性膜性肾病的疗效研究

Effect of tacrolimus combined with small dose of glucocorticoid and entecavir on HBV-associated membranous nephropathy

目的探讨他克莫司联合小剂量糖皮质激素和恩替卡韦对乙型肝炎病毒(HBV)相关性膜性肾病的疗效,为患者的临床诊治提供理论依据。方法选取2014-2017年在郑州大学第一附属医院就诊的HBV相关性膜性肾病患者80例进行研究。按治疗方式的不同,均分为观察组(n=40)和对照组(n=40)。对照组给予0.5 mg/d恩替卡韦治疗,观察组在对照组治疗的基础上,给予0.05 mg/(kg·d)他克莫司联合小剂量糖皮质激素[0.5 mg/(kg·d)醋酸泼尼松]治疗。观察两组患者的治疗效果,记录两组患者治疗前及治疗6个月24 h尿蛋白定量及血清白蛋白水平、肝功能情况,比较两组患者治疗后乙肝病毒的脱氧核糖核酸(HBV DNA)、乙肝表面抗原(HBsAg)、乙型肝炎E抗体(HBeAb)变化,统计不良反应发生情况。结果治疗6个月后,观察组患者的病情总缓解率为97.50%,明显高于对照组的72.50%,差异有统计学意义(x2=8.823,P<0.05)。治疗3~6个月后,观察组患者血清白蛋白水平明显高于对照组,且观察组患者的24 h尿蛋白定量、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶水平均明显低于对照组,差异均有统计学意义(P<0.05)。两组患者治疗6个月后HBV DNA、HBsAg、HBeAb比较,差异均无统计学意义(P>0.05)。观察组有1例失眠,不良反应发生率为2.50%,明显低于对照组的1例恶心、5例失眠、1例感染,不良反应发生率17.50%,差异有统计学意义(x2=5.000,P<0.05)。结论他克莫司联合小剂量糖皮质激素和恩替卡韦治疗HBV相关性膜性肾病的疗效显著,能有效控制患者的24 h尿蛋白定量,提高血清白蛋白水平的同时,保护患者的肝肾功能,且不良反应情况较少,值得临床推广使用。

Objective To investigate the effect of tacrolimus combined with low-dose glucocorticoid and entecavir on membrane nephropathy associated with hepatitis B virus(HBV) associated membranous nephropathy,and provide a theoretical basis for the clinical diagnosis and treatment of patients.Methods 80 cases patients with HBV-related membranous nephropathy treated in our hospital from 2014 to 2017 were selected for study.According to different treatment methods,the patients were divided into observation group(n=40) and control group(n=40).The control group was treated with 0.5 mg/d entecavir;patients in the observation group were given 0.05 mg/(kg·d) tacrolimus combined with small doses of glucocorticoid 0.05 mg/(kg·d) prednisolone acetate and 0.5 mg/(kg·d) entecavir.To observe the therapeutic effect of the two groups of patients,the urinary protein quantification,serum albumin level and liver function of the two groups of patients before and 6 months of treatment were recorded;the changes of hepatitis B virus DNA(HBV DNA),hepatitis B surface antigen(HBsAg),and hepatitis B E antibody(HBeAb) of the two groups of patients after treatment were compared,and adverse reactions were counted.Results After 6 months of treatment,the overall remission rate of patients in the observation group was 97.50%,which was significantly higher than 72.50% in the control group(χ~2=8.823,P<0.05).After 3-6 months of treatment,the serum albumin levels in the observation group were significantly higher than those in the control group,and the 24-hour urine protein quantification,aspartate aminotransferase,and alanine aminotransferase levels in the observation group were significantly lower than those in the control group(P<0.05).Compared of HBV DNA,HBSAg,HBeAb after 6 months of treatment between the two groups of patients,the difference was not statistically significant(P>0.05).There was 1 case of insomnia in the observation group;the incidence of adverse reactions was 2.50%,which was significantly lower than that of the control group(1 case of nausea,5 cases of insomnia,and 1 infection;17.50%)(χ~2=5.000,P<0.05).Conclusion The efficacy of tacrolimus combined with low-dose glucocorticoids and entecavir in the treatment of HBV-associated membranous nephropathy was significant;it could effectively control the patient s 24 h urine protein quantitatively,at the same time increasing serum albumin level,protecting the liver and kidney function of patients,and there are fewer adverse reactions,which should worthy of clinical promotion.