摘要
目的对比研究阿德福韦酯、恩替卡韦及替比夫定抗病毒药物治疗慢性乙型肝炎不同时间点的肾小球滤过率估计值(eGFR),为临床选择合适的核苷类似物抗病毒药物提供参考。方法选取2014年2月至2016年4月湖北医药学院附属人民医院收治的慢性乙型肝炎患者206例,根据抗病毒药物种类分为阿德福韦酯组(70例)、恩替卡韦组(65例)及替比夫定组(71例)。根据性别、年龄和血肌酐,利用苦味酸法计算eGFR数值,统计对比3组患者治疗前(T_0)、治疗后6、12、24个月(T_1、T_2、T_3)的肌酐(SCr)、eGFR水平,比较3组的谷丙转氨酶(ALT_)复常率及HBV-DNA转阴率。结果阿德福韦酯组T_1、T_2、T_3时SCr水平均高于T_0,替比夫定组T_1、T_2、T_3时SCr水平均低于T_0,差异有统计学意义(P均<0.05);恩替卡韦组T_0、T_1、T_2、T_3时SCr水平比较,差异无统计学意义(P>0.05);T_1、T_2、T_3时,阿德福韦酯组SCr水平高于恩替卡韦组和替比夫定组,且恩替卡韦组高于替比夫定组,差异有统计学意义(P均<0.05)。阿德福韦酯组T_1、T_2、T_3时eGFR水平均低于T_0,替比夫定组T_1、T_2、T_3时eGFR水平均高于T_0,差异有统计学意义(P均<0.05);恩替卡韦组T_0、T_1、T_2、T_3时eGFR水平比较,差异无统计学意义(P>0.05);T_1、T_2、T_3时,阿德福韦酯组患者eGFR水平低于恩替卡韦组和替比夫定组,且恩替卡韦组低于替比夫定组,差异有统计学意义(P均<0.05)。3组治疗后ALT_复常率及HBV-DNA转阴率比较,差异无统计学意义(P>0.05)。结论长期服用替比夫定能提高慢性乙型肝炎患者的eGFR水平,长期服用阿德福韦酯会引起患者eGFR水平下降;恩替卡韦不会对eGFR水平产生影响。临床治疗慢性乙型肝炎时应该尽可能选择替比夫定抗病毒药物,必要时可联合恩替卡韦治疗。
Objective To compare the eGFR values of adefovir dipivoxil, entecavir and telbivudine antiviral drugs at different time points in patients with chronic hepatitis B for providing a reference for clinical selection of appropriate nucleoside analog anti - viral drugs. Methods Two hundred and six patients with chronic hepatitis B admitted to the People＇ s Hospital of Hubei Medical College from February of 2014 to April of 2016 were divided into adefovir dipivoxil group （70 cases）, entecavir group （65 cases ） and telbivudine group （71 cases）. According to the sex, age and serum creatinine, the eGFR value was calculated by picric acid method. The levels of creatinine （ SCr）, eGFR, ALT normalization rate and HBV - DNA negative rate of the three groups were compared. Results There was no significant difference in the levels of SCr and eGFR of entecavir group at To, T1 , T2 and T3 （P 〉 0. 05）. The levels of SCr at T1 , T2 and T3 of adefovir dipivoxil group were all higher than that of To, the levels of SCr at T1 , T2 and T3 of telbivudine group were all lower than that of To, the levels of SCr of adefovir dipivoxil group were higher than those of enteeavir group and telbivudine group at T1, T2 and T3 , and the levels of entecavir group were higher than telbivudine group（ P all 〈 0. 05 ）. The levels of eGFR at T1 , T2 and T3 of adefovir dipivoxil group were all lower than that of To, the levels of eGFR at T1, T2 and T3 of telbivudine group were higher than that of To, the levels of eGFR of adefovir dipivoxil group were lower than those of entecavir group and telbivudine group at T1 , T2 and T3 , and the levels of entecavir group were lower than those of telbivudine group （ P all 〈 0.05 ）. There was no signifi- cant difference in ALT normalization rate and HBV - DNA negative rate after treatment among the three groups （ P 〉 0.05 ）. Conclusion Long - term telbivudine can increase eGFR level in patients with chronic hepatitis B, long - term use of adefovir dipivoxil will cause eGFR level decreased, and entecavir will not affect eGFR level. Telbivudine should be the drug of choice for the treatment of chronic hepatitis B, and it can be combined with Entecavir if necessary.
出处
《河南医学研究》
CAS
2017年第23期4228-4231,共4页
Henan Medical Research
作者简介
通讯作者：杨文昊，E—mail：2554848859@qq．com。
