替诺福韦和/或恩替卡韦在慢性HBV单感染患者中的肾脏安全性

StephenW

Ther Clin Risk Manag. 2017 Sep 26;13:1273-1285. doi: 10.2147/TCRM.S143286. eCollection  2017.
Renal safety of tenofovir and/or entecavir in patients with chronic HBV monoinfection.Yang YM1, Choi EJ1.
Author information
1Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea.

AbstractBACKGROUND: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) are recommended as the first-line therapy for chronic hepatitis B (CHB) due to their genetic barrier to resistance and effectiveness of virological suppression. TDF and ETV may cause renal toxicity through various mechanisms such as renal tubular injury, apoptosis, and mitochondrial toxicity. The aims of the current review were to assess the potential renal toxicity associated with the use of TDF and ETV in patients infected with chronic hepatitis B virus (HBV) and to provide clinical perspectives on these two agents in the treatment of CHB.
METHODS: A literature search of clinical studies published in PubMed and posted on ClinicalTrials.gov website was implemented to find studies evaluating the potential renal toxicity of TDF and ETV.
RESULTS: Twenty-one studies were examined in this review. The TDF dose used in the studies was 245 or 300 mg/day and that of ETV was 0.5 or 1 mg/day. Based on the markers of renal function, patients treated with TDF were not more likely to show changes in renal function than those treated with ETV; however, the estimated glomerular filtration rates (eGFRs) of patients receiving TDF tended to be more clearly reduced than those of patients receiving ETV. The eGFRs of patients treated with TDF decreased in a time-dependent manner, whereas those of patients treated with ETV increased or decreased across various time points.
CONCLUSION: The data shown in this study suggest that use of TDF and ETV could be at least associated with reductions in renal function in patients with chronic HBV infection. However, various risk factors, such as pre-existing renal failure and comorbidities, are also associated with decreased renal function during the treatment of TDF and ETV. Thus, studies of management strategies for HBV-infected patients with these risk factors are necessary in the near future.


KEYWORDS: entecavir; hepatitis B; renal safety; tenofovir

PMID:29033575PMCID:PMC5628694DOI:10.2147/TCRM.S143286

StephenW

Ther Clin风险管理2017年9月26日; 13：1273-1285。 doi：10.2147 / TCRM.S143286。 eCollection 2017。
替诺福韦和/或恩替卡韦在慢性HBV单感染患者中的肾脏安全性。
杨奕1，崔EJ1。
作者信息

1
    朝鲜光州大学药剂学系药学系。

抽象
背景：

推荐使用替诺福韦来氟米尔富马酸盐（TDF）和恩替卡韦（ETV）作为慢性乙型肝炎（CHB）的一线治疗，因为它们对病毒学抑制的抵抗和有效性具有遗传性障碍。 TDF和ETV可能通过肾小管损伤，细胞凋亡和线粒体毒性等各种机制引起肾毒性。本次评估的目的是评估与感染慢性乙型肝炎病毒（HBV）的患者使用TDF和ETV相关的潜在肾毒性，并为这两种药物治疗CHB提供临床观点。
方法：

实验发现PubMed公布的临床研究文献和ClinicalTrials.gov网站上发表的临床研究文献，以找出评估TDF和ETV潜在肾脏毒性的研究。
结果：

在这次审查中审查了21项研究。研究中使用的TDF剂量为245或300mg /天，ETV剂量为0.5或1mg /天。根据肾功能标志物，用TDF治疗的患者肾功能变化不如ETV治疗组，然而，接受TDF的患者的估计肾小球滤过率（eGFR）往往比接受ETV的患者更明显地降低。用TDF治疗的患者的eGFRs以时间依赖性方式下降，而经ETV治疗的患者的eGFR在不同时间点上升或下降。
结论：

本研究中显示的数据表明，使用TDF和ETV可能至少与慢性HBV感染患者的肾功能降低有关。然而，诸如预先存在的肾衰竭和合并症的各种危险因素也与TDF和ETV治疗期间的肾功能降低有关。因此，在不久的将来，有必要对具有这些危险因素的HBV感染患者的管理策略进行研究。
关键词：

恩替卡韦;乙型肝炎肾脏安全;替诺福韦

结论：
    29033575
PMCID：
    PMC5628694
DOI：
    10.2147 / TCRM.S143286

StephenW

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628694/

hp121

啥意思

哪个影响更大？？？

antiHBVren

回复 hp121 的帖子

接受TDF的患者的估计肾小球滤过率（eGFR）往往比接受ETV的患者更明显地降低。用TDF治疗的患者的eGFRs以时间依赖性方式下降，而经ETV治疗的患者的eGFR在不同时间点上升或下降。

hp121

回复 antiHBVren 的帖子

也就是TDF这方面副作用比恩替大很多是吧

kite2002005

这也不是说，恩梯也会影响，不是吗

antiHBVren

回复 kite2002005 的帖子

是的，都有影响；
TDF：随着使用时间增加，eGFR不断下降；
ETV稍好，但是对肾功影响同样很大；
还是密切观察自己，一有突破底线迹象，换TAF吧

hp121

回复 antiHBVren 的帖子

TAF就没有影响了？？

或者说比前两者都好？？

肾小球滤过率（eGFR）怎么查？？肾功能里有这项目吗？？

我只记得肌酐，这个指标是否也可以参考？？

hp121

回复 antiHBVren 的帖子

在网上查

现在貌似肾小球滤过率（eGFR）最佳指标是胱抑素C检测

不知道一般的三甲医院是否有这项目