替诺福韦对慢性乙型肝炎患者肾功能的影响

StephenW

Medicine (Baltimore). 2018 Feb;97(7):e9756. doi: 10.1097/MD.0000000000009756.
Effect of tenofovir on renal function in patients with chronic hepatitis B.Jung WJ1, Jang JY1, Park WY1, Jeong SW1, Lee HJ1, Park SJ1, Lee SH2, Kim SG3, Cha SW1, Kim YS3, Cho YD1, Kim HS2, Kim BS1, Park S4, Baymbajav B5.
Author information
1Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul.2Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan.3Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon.4Biostatistical Consulting Unit, Soonchunhyang University, Seoul, Korea.5UB Songdo Hospital, Ulaanbaatar, Mongolia.

AbstractTenofovir disoproxil fumarate (TDF) is widely used to treat patients with hepatitis B virus (HBV) infection. We investigated the effect of TDF on renal insufficiency in patients with chronic hepatitis B (CHB).A consecutive cohort analysis was applied to CHB patients taking prescribed TDF from January 2012 to May 2016 at Soonchunhyang University Seoul Hospital. Alterations over time in corrected calcium, phosphate, creatinine, and estimated glomerular filtration rate (eGFR) were analyzed using the generalized estimating equation method. The percentage increase in creatinine from baseline to the maximum creatinine level (delta creatinine) was compared according to the underlying disease using the Mann-Whitney U test. Cox proportional hazard regression model was used to determine risk factors associated with renal insufficiency.The baseline creatinine, eGFR, corrected calcium, and phosphate levels were 0.72 ± 0.01 mg/dL (mean ± SD), 106.37 ± 1.06 mL/min/1.73 m, 8.82 ± 0.04 mg/dL, and 3.42 ± 0.05 mg/dL, respectively. The creatinine level had increased significantly at 12, 24, 48, 72, and 96 weeks, while the eGFR level had decreased significantly at these 5 time points. Multivariate analysis confirmed that age ≥60 years and the baseline bilirubin level were independently associated with the risk of renal insufficiency. Delta creatinine was significantly higher in patients with diabetes mellitus (DM) than in patients without DM.Renal function was decreased from baseline in CHB patients receiving TDF therapy, which indicates that the renal function of patients undergoing treatment with TDF should be monitored regularly. Old age, DM, and serum bilirubin were risk factors for the development of renal insufficiency in CHB patients receiving TDF therapy.


PMID:29443737DOI:10.1097/MD.0000000000009756

StephenW

医学（巴尔的摩）。 2018年2月; 97（7）：e9756。 doi：10.1097 / MD.0000000000009756。
替诺福韦对慢性乙型肝炎患者肾功能的影响
Jung WJ1，Jang JY1，Park WY1，Jeong SW1，Lee HJ1，Park SJ1，Lee SH2，Kim SG3，Cha SW1，Kim YS3，Cho YD1，Kim HS2，Kim BS1，Park S4，Baymbajav B5。
作者信息

1
    汉城顺天大学医学院消化疾病中心消化疾病研究所。
2
    天津市顺天大学医学院内科。
3
    医学院内分泌科，顺天大学，富川市。
4
    韩国首尔Soonchunhyang大学生物统计咨询部。
五
    UB松岛医院，蒙古乌兰巴托。

抽象

替诺福韦地索普西富马酸盐（TDF）广泛用于治疗乙型肝炎病毒（HBV）感染的患者。我们调查了TDF对慢性乙型肝炎患者（CHB）患者肾功能不全的影响。在2012年1月至2016年5月期间，在Soonchunhyang大学首尔医院对CHB患者采用了规定的TDF进行连续队列分析。使用广义估计方程方法分析校正的钙，磷酸盐，肌酸酐和估计的肾小球滤过率（eGFR）随时间的变化。使用Mann-Whitney U检验根据基础疾病比较肌酸酐从基线至最大肌酐水平（δ肌酸酐）的百分比增加。使用Cox比例风险回归模型来确定与肾功能不全有关的危险因素。基线肌酐，eGFR，校正的钙和磷酸盐水平分别为0.72±0.01mg / dL（平均值±SD），106.37±1.06mL / min / 1.73m ，8.82±0.04mg / dL和3.42±0.05mg / dL。肌酐水平在12,24,48,72和96周时显着增加，而eGFR水平在这5个时间点显着降低。多变量分析证实年龄≥60岁和基线胆红素水平与肾功能不全风险独立相关。糖尿病患者的DM肌酐显着高于无DM患者。接受TDF治疗的CHB患者的肾功能从基线水平降低，这表明接受TDF治疗的患者的肾功能应定期监测。老年，DM和血清胆红素是接受TDF治疗的CHB患者发生肾功能不全的危险因素。

结论：
    29443737
DOI：
    10.1097 / MD.0000000000009756

StephenW

https://journals.lww.com/md-jour ... in_patients.11.aspx

桦子

服用TDF, 观察肾功能，我们通常只关注钙、磷酸盐、肌酸酐和肾小球滤过率，
这篇文章提出“…血清胆红素是接受TDF治疗的CHB患者发生肾功能不全的危险因素”
蕴含新的观点，除了密切关注钙、磷酸盐、肌酸酐和肾小球滤过率，我们还要留意血清胆红素
这个指标。

StephenW

回复 桦子 的帖子

是的，这个研究确定低血清白蛋白作为肾效率低下的一个危险因素.

"在一项接受抗病毒药物治疗的4178例慢性乙型肝炎患者的研究中，与稳定肾功能患者相比，慢性肾脏疾病进展快的患者血清白蛋白降低，总胆红素升高，凝血酶原时间延长。 [29]一个合理的解释是肝功能不全患者易发生肾功能不全。"

桦子

回复 StephenW 的帖子

谢谢指导！春节快乐！