抗病毒药物对慢性乙肝患者肾功能影响的研究

陈雪霞

(海南省文昌市人民医院感染科，文昌571300)

摘要：目的 研究恩替卡韦和阿德福韦酯对慢性乙型肝炎(CHB)患者肾功能的影响。方法 选取在我院进行治疗的慢性乙型肝炎患者98例，随机分为恩替卡韦(ETV)组49例和阿德福韦酯(ADV)组49例。2组患者分别采用适量对应药物进行抗病毒治疗。收集2组患者治疗前和治疗后12周、48周的乙肝病毒(HBV)DNA含量、血清肌酐(CR)和肾小球滤过率(eGFR)的水平，以及2组患者治疗12周、48周后HBV-DNA的转阴率、丙氨酸氨基转移酶(ALT)复常率和完全应答率的数据。结果 所有患者HBV-DNA水平在治疗后有所降低，2组患者的HBV-DNA含量和转阴率、ALT复常率和完全应答率数据比较，差异明显，具有统计学意义。CR和eGFR含量仅在治疗48周后比较数据，差异明显，具有统计学意义。在治疗前和治疗后12周比较数据，差异无统计学意义。结论 恩替卡韦比阿德福韦酯具有更强的抑制HBV-DNA作用，能够更好的改善肾功能。

关键词：恩替卡韦；阿德福韦酯；慢性乙型肝炎；血清肌酐；肾小球滤过率

doi:10.3969/j.issn.1004-2407.2015.06.020

中图分类号：R978.7文献标志码：A

收稿日期：(2015-05-26)

Study on the influence of antiviral drugs on kidney function in patients with chronic hepatitis

CHEN Xuexia(The People′s Hospital of Hainan Province, Wenchang City Department of Infection，Wenchang 571300，China)

Abstract:Objective To study the therapeutic effect of entecavir and adefovir dipivoxil on renal function. Methods 98 cases of chronic hepatitis B patients in our hospital were selected, and randomly divided into entecavir (ETV) group of 49 cases and adefovir dipivoxil (ADV) group of 49 cases. The two groups of patients received the corresponding antiviral drug therapy. Before the treatment and after the treatment 12 and 48 weeks, hepatitis B virus (HBV) DNA, serum creatinine (CR) , glomerular filtration rate (eGFR) levels, as well as the negative rate of HBV-DNA, and calamine aminotransferase (ALT) were statistically analyzed. Results For all patients, HBV-DNA levels decreased after the treatment, HBV-DNA content, ALT normalization rate and the complete response rate data of the two groups showed significant difference, after the treatment of 12 weeks the difference was not statistically significant. Conclusion Compared with adefovir, entecavir has a stronger role in inhibiting HBV-DNA, and improvement in renal function.

Key words: entecavir；adefovir dipivoxil；chronic hepatitis B；serum creatinine； glomerular filtration rate

HBV的治疗方向主要有免疫抑制治疗和抗病毒治疗[1-2]，其中抗病毒治疗是治疗慢性乙型肝炎的基础[3]。《慢性乙型肝炎防治指南》指出，长时间消除或抑制HBV发作[4]，组织和延缓疾病的进一步发展是HBV的最终治疗目标，进一步达到尽量延长存活时间和改善生活质量的根本治疗目的，同时指出CR和eGFR含量是判定肾功能的重要指标。研究表明，阿德福韦酯有一定的肾脏毒性，并与剂量相关，恩替卡韦是鸟嘌呤核苷类似物，具有很强的病毒抑制作用，能有效抑制HBV-DNA复制，在治疗慢性乙型肝炎中能够起到改善肾功能的作用。……