诺福韦治疗慢性乙肝患者的肾毒性风险和恩替卡韦类似

肝胆速递

http://www.ncbi.nlm.nih.gov/pubmed/22507876?dopt=Abstract
Clin Gastroenterol Hepatol. 2012 Aug;10(8):941-6; quiz e68. Epub 2012 Apr 13.
Similar risk of renal events among patients treated with tenofovir or entecavir for chronic hepatitis B.
诺福韦治疗慢性乙肝患者的肾毒性风险和恩替卡韦类似

Gish RG, Clark MD, Kane SD, Shaw RE, Mangahas MF, Baqai S.
Source

University of California at San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA. [email protected]
Abstract
BACKGROUND
AIMS:

Tenofovir is a nucleotide reverse-transcriptase inhibitor approved for treatment of human immunodeficiency virus infection, as well as chronic hepatitis B (CHB). We evaluated nephrotoxicity among patients with CHB treated with tenofovir.
METHODS:

We performed a community-based, retrospective cohort study of 80 patients with CHB who received tenofovir, alone or in a combination regimen; they were matched for age and sex with 80 CHB patients who received only entecavir. Incidences of serum creatinine (SCr) increase ≥0.2 mg/dL and new SCr levels of 1.5, 2.0, or 2.5 mg/dL were assessed. Patients with an estimated glomerular filtration rate (eGFR) <60 mL/min, calculated using the Modification of Diet in Renal Disease or Cockcroft-Gault formula, or who had ≥20% decrease in eGFR were also recorded.
RESULTS:

More patients given entecavir had increases in SCr ≥2.5 mg/dL (1 vs 6; P = .053), whereas more patients given tenofovir had a new Cockcroft-Gault eGFR of <60 mL/min (15 vs 6; P = .022) and at least 1 dose adjustment (13 vs 4; P = .021). By multivariate analysis, the only significant factors associated with an increase in SCr were a history of organ transplantation (adjusted odds ratio, 6.740; 95% confidence interval, 1.799-28.250; P = .005) and pre-existing renal insufficiency (adjusted odds ratio, 10.960; 95% confidence interval, 2.419-48.850; P = .002). No factors, including therapy assignment, were associated with a new eGFR <60 mL/min.
CONCLUSIONS:

Markers of renal function indicated that patients who received tenofovir were no more likely to have changes in renal function than patients treated with entecavir. History of transplant and pre-existing renal insufficiency were the only factors independently associated with increases in SCr.

肝胆速递

临床胃肠病学杂志肝脏病杂志。 2012年8月，10（8）:941-6;竞猜E68。 EPUB 2012年4月13日。
类似的风险替诺福韦或恩替卡韦治疗慢性B型肝炎的患者的肾脏事件
的吉什RG，克拉克博士，凯恩SD，肖RE MF，Baqai S.，Mangahas
源

美国加州大学圣地亚哥植树节驱动器，圣迭戈，CA 92103，USA，200 W.。 [email protected]
抽象
背景与目的：

替诺福韦核苷酸逆转录酶抑制剂已批准用于治疗人类免疫缺陷病毒感染，以及慢性乙型肝炎（CHB）。我们评估了替诺福韦治疗慢性乙型肝炎患者的肾毒性之间。
方法：

我们进行了一项以社区为基础的回顾性队列研究的80例慢性乙型肝炎患者替诺福韦，单独或组合方案，他们只接受恩替卡韦与80例慢性乙型肝炎患者的年龄和性别相匹配的。血清肌酐增加≥0.2 mg / dL和新的SCr水平为1.5，2.0，或2.5毫克/升的发生率进行了评估。患者估计肾小球滤过率（eGFR）<60毫升/分钟，使用的改性饮食肾脏疾病或Cockcroft-Gault公式，或有≥20％的减少，表皮生长因子受体亦录得计算。
结果：

更多的患者恩替卡韦的提高，在血肌酐≥2.5毫克/分升（1比6，P = 0.053），而更多的患者替诺福韦有一个新的克罗夫特 - 高尔特EGFR <60毫升/分（15比6，P =。 022）和至少1个剂量调整（13比4，P = .021）。多变量分析显示，与血肌酐增加的唯一重要的因素，是一个历史的器官移植（校正胜算比为6.740; 95％的置信区间1.799-28.250，P = 0.005）和预先存在的肾功能不全（调整后的比值比，10.960，95％的置信区间2.419-48.850，P = 0.002）。任何因素，包括治疗分配，用一个新的eGFR <60 mL / min的关联。
结论：

肾功能的指标表明，患者谁收到替诺福韦是没有比用恩替卡韦治疗的患者更可能有肾功能的变化。移植的历史和预先存在的肾功能不全是唯一的独立与SCr的增加相关联的因素