替诺福韦会导致白种人慢性乙型肝炎患者肾功能损害

tonychant

HBV聚合酶抑制剂对慢性乙型肝炎患者肾功能的影响（Effect of HBV polymerase inhibitors on renal function in patients with chronic hepatitis B）
背景与目的：HBV聚合酶抑制剂治疗慢性乙型肝炎，特别是替诺福韦或阿德福韦，可能会影响肾功能。为了更精确评估在正常范围内的肾功能，我们使用最近确认的慢性肾脏病流行病学协作（CKD - EPI）公式计算估计肾小球滤过率（eGFR）。

方法：亚组患者包括：将单菌性感染HBV患者分为拉米夫定组(n = 36)、阿德福韦酯（n = 32）、恩替卡韦（n =32）或替诺福韦（n = 37）。HbsAg阳性未治疗患者(n = 60)作为对照组。我们对比较接受基于抗逆转录病毒疗法的泰诺福韦（n =120）或齐多夫定（n = 52）治疗的单菌性传染HIV患者与抗逆转录病毒首次治疗患者(n = 109) 进行了评估。使用CKD-EPI方程来计算eGFR。以一种更为敏感的方法，我们用线性混合效应模型（LME）模拟个体患者随着时间的推移的eGFR的变化。
结果：依据LME模型年预测的个体eGFR变化中位数为：未治疗HBV，−2.05 ml/min；拉米夫定HBV，−0.92 ml/min；阿德福韦HBV，−1.02 ml/min；恩替卡韦HBV，−1.00 ml/min；替诺福韦HBV，−0.92 ml/min（未经治疗HBV vs经治疗的HBV，p <0.01）。对于单菌性感染HBV患者：未经治疗HIV −0.62 ml/min；替诺福韦治疗HIV，−2.64 ml/min；齐多夫定治疗HIV，−1.0 ml/min（替诺福韦vs 未经治疗，p = 0.017；替诺福韦vs齐多夫定，p <0.001）。

结论：不论服用哪种药物，HBV感染治疗似乎导致轻度肾功能下降。相反，替诺福韦作为HIV联合治疗的一部分似乎会导致白种人肾功能损害。J Hepatol. 2011 Dec;55(6):1235-40）

你问我是谁

这篇文章放在这里可惜
发到乙肝交流区甚好
这里看到的人少

StephenW

AASLD 2011 HBV Coverage by Christine M. Kukka
Side effects from antivirals examined
肝病学会2011 HBV覆盖由Christine M. Kukka
检查抗病毒药物的副作用
Tenofovir and entecavir: No threat to kidneys?
Increasingly, researchers are reporting that some antivirals cause kidney damage (and harming renal function) and are finding side effects. They followed 212 patients treated with tenofovir and 79 treated with entecavir (most were male, half were African-American, and 24% were Asian-American.)
They monitored their renal function at the start of treatment, and six and 12 months later and found no deterioration in renal function in the tenofovir-treated patients, and only a small impact on renal function in the entecavir-treated group.
# 496 A single centre, large 'real-life' cohort treated with tenofovir versus entecavir: no deterioration in renal function.
泰诺福韦和恩替卡韦：没有肾脏的威胁？
越来越多的研究人员报告，一些抗病毒药物引起的肾功能损害（和肾功能损害），并发现副作用。他们随后与替诺福韦和恩替卡韦治疗79治疗的212例患者（大部分是男性，一半是非裔美国人，24％的亚裔美国人。）
他们在治疗，6个月和12个月后开始监测其肾功能，并没有发现替诺福韦治疗的患者的肾功能恶化，只有在恩替卡韦治疗组肾功能的影响小。

#496一个单一的中心，大的“现实生活”的队列与恩替卡韦替诺福韦治疗：无肾功能恶化。

Other doctors find kidney damage from antivirals
其他医生发现抗病毒药物的肾脏损害
Increasingly, doctors are finding that long-term use of antivirals causes kidney damage, as evidence by reduced renal function. French researchers followed 220 antiviral-treated patients (mostly male, average age 47), including 30% with extensive fibrosis or
cirrhosis, who were treated for an average 4.6 years. Researchers found above-average rates of renal impairment among the antiviral-treated patients.
#1444. Renal impairment under nucleotide analogues in a monocentric cohort of patients with chronic HBV monoinfection.
越来越多，医生们发现，长期使用抗病毒药物会导致肾功能损害，肾功能降低的证据。法国研究人员随后220抗病毒药物治疗的患者（多为男性，平均年龄47），其中包括30％或广泛纤维化肝硬化，平均4.6年的治疗。抗病毒药物治疗的患者中，研究人员发现，高于平均水平的利率，肾功能不全。

#1444。根据在慢性乙肝monoinfection患者的单中心队列的核苷类似物的肾损害。

Weakened bones found in tenofovir- and adefovir-treated patients
A National Institutes of Health study found phosphate wasting nephropathy in between 10 and 15% of patients treated for two years with either tenofovir or adefovir.
They followed 51 patients treated for an average 6.3 with the two antivirals, and reported that 14% developed phosphate wasting nephropathy, which can lead to bone softening and degeneration, after an average of three years.
The problem is, “partially reversible with change to other antivirals,” researchers wrote, “but may result in significant osteomalacia (bone softening) if not recognized and managed promptly. Routine monitoring of serum phosphate, creatinine, uric acid and urinalysis is prudent during long-term adefovir and tenofovir therapy.”
#237 Phosphate Wasting Nephropathy in Patients with Chronic Hepatitis B treated with Long-term Adefovir or Tenofovir.
泰诺福韦和阿德福韦治疗的患者中发现削弱骨骼
一个美国国立卫生研究研究院发现磷酸浪费肾病两年要么替诺福韦或阿德福韦治疗的患者在10至15％。
他们按照平均6.3两个抗病毒药物治疗的51例患者，并上报后三年平均14％磷酸盐肾病的浪费，从而导致骨软化和变性，。
问题是，“部分可逆的改变其他抗病毒药物，”研究人员写道，“但可能显著软骨病（骨软化）的结果，如果不及时识别和管理。血磷，肌酐，尿酸和尿液的常规监测是在长期阿德福韦和替诺福韦治疗的谨慎。“
#237磷酸盐浪费肾病患者长期阿德福韦或替诺福韦治疗慢性乙型肝炎乙。

A similar study in Italy looked at the bone mineral density of 124 patients treated with lamivudine and/or tenofovir. They found 77% of the patients had no signs of bone weakening, 8% actually had improved bone density, but 15% had suffered bone loss.
#1385. The course of bone mineral density in patients with chronic hepatitis B long-term treated with nucleos(t)ide analogs: a longitudinal cohort study.
在意大利类似的研究在与拉米夫定和/或替诺福韦治疗的124例患者的骨密度。他们发现，77％的患者有骨弱化的迹象，实际上得到了改善8％的骨质密度，但遭受了15％的骨质流失。
#1385。一个纵向队列研究：慢性乙肝长期治疗核苷（酸）IDE类似物的患者中骨密度。

烦恼神仙

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jiujiuwoyigan

水桶原理，人的生命长短是最差的一个器官决定的，用肾的轻微损害换肝的转好，最后两个器官一起挂就最理想状态了

杨震

替诺看来也不是神药啊！