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EASL 2018 FRI-332 Is renal impairment associated with chronic hepatitis B - a propensity score matched study of healthy non-hepatitis B patients compared to patients with untreated chronic hepatitis B
V. Vu, S. Trinh,A. Le, T. Johnson, J. Hoang, D. Jeong, L. Henry,M. Nguyen. Stanford University Medical Center, Division of Gastroenterology and Hepatology
Email: [email protected]
Background and Aims:
Renal impairment has been suggested to occur at higher rate in patients with chronic hepatitis B (CHB). However, questions have been raised as to whether the prevalence of renal impairment is a result of the virus itself, a result of HBV treatment, or other factors. The studyaimwas to explore and compare renal function over time between healthy non-CHB patients and untreated CHB patients.
Method:
Healthy non-CHB patients and patients infected with HBV were recruited from a retrospective cohort of consecutive adult patients at one U.S. tertiary center and 3 community gastroenterology and primary care clinic between 1996 and 2017. Healthy non-CHB patients were recruited if they had no history of liver disease, congestive heart failure, human immunodeficiency virus (HIV), or cancer. CHB patients were recruited if they had no hepatitis D virus, hepatitis C virus, or HIV coinfections. Patients were included in the study if they had never received HBV treatment, had =>12months of serial creatinine labs, and had a baseline estimated glomerular filtration rate (eGFR, calculated using the Modification of Diet in Renal Disease Study equation) =>60 ml/min/1.73 m2 (healthy n = 26, 519; CHB n = 290). Propensity score matching (PSM) for age, sex, race (Asian vs. non-Asian), diabetes (DM), hypertension (HTN), and baseline eGFR was performed to balance the two groups. Generalized linear regression modeling (GLM) adjusting for sex, race, DM and HTN was performed to generate mean eGFR over time.
Results:
The PSM groups included 290 healthy non-CHB patients and 290 untreated CHB patients (n = 580). Mean age was 42 ± 12 years. More than half were male (51%) and a majority were Asian (88%). Forty-nine patients had DM (9%) and 143 patients had HTN (25%). Patients had a median baseline eGFR of 88.3 (IQR = 61.0–143.9) and a median follow-up of 82 months (IQR = 12–217). On GLM, the mean eGFR was significantly higher for healthy non-CHB patients compared to untreated CHB patients (87.4 vs. 85.6, p = 0.004) (Figure).
Conclusion:
In this PSM study, untreated CHB patients’ eGFR over time decreased significantly more than the healthy non-CHB patients; however, the change in eGFR may not be clinically significant, at least in short-to-medium term follow-up. Therefore, further research is needed to determine which factors may have contributed to renal impairment in patients with CHB.
EASL 2018 FRI-332肾脏损害与慢性乙型肝炎相关 - 与未治疗的慢性乙型肝炎患者相比，健康非乙型肝炎患者的倾向评分匹配研究
V. Vu，S. Trinh，A。 Le，T. Johnson，J. Hoang，D. Jeong，L. Henry，M。阮。斯坦福大学医学中心，消化内科和肝病科
电子邮件：[email protected]
背景和目标：
慢性乙型肝炎（CHB）患者的肾功能损害发生率较高。但是，有关肾损害的流行是由于病毒本身，HBV治疗的结果还是其他因素导致的问题已经提出。该研究旨在探索和比较健康非CHB患者和未治疗CHB患者随时间的肾功能。
方法：
健康非CHB患者和感染HBV的患者在1996年至2017年期间从一个美国三级中心和3个社区胃肠病学和初级保健诊所的连续成人患者的回顾性队列中招募。健康的非CHB患者如果他们没有历史记录被招募肝病，充血性心力衰竭，人类免疫缺陷病毒（HIV）或癌症。 CHB患者如果没有丁型肝炎病毒，丙型肝炎病毒或艾滋病毒合并感染，就会被招募。如果患者从未接受过HBV治疗，并且系列肌酐实验室≥12个月，并且具有基线估计的肾小球滤过率（eGFR，使用饮食在肾病研究中的改变方程式计算）=> 60 ml /min/1.73m2（健康n = 26,519; CHB n = 290）。对年龄，性别，种族（亚洲与非亚洲），糖尿病（DM），高血压（HTN）和基线eGFR进行倾向评分匹配（PSM）以平衡两组。进行调整性别，种族，DM和HTN的广义线性回归模型（GLM）以产生随时间推移的平均eGFR。
结果：
PSM组包括290名健康的非CHB患者和290名未经治疗的CHB患者（n = 580）。平均年龄为42±12岁。一半以上是男性（51％），大部分是亚洲人（88％）。 49名患者有DM（9％），143名患者有HTN（25％）。患者的基线eGFR中位数为88.3（IQR = 61.0-143.9），中位随访时间为82个月（IQR = 12-217）。在GLM上，健康非CHB患者的平均eGFR显着高于未治疗的CHB患者（87.4对85.6，p = 0.004）（图）。
结论：
在这项PSM研究中，未经治疗的慢性乙型肝炎患者的eGFR随着时间的推移显着降低，明显高于健康的非CHB患者;然而，eGFR的变化可能并不具有临床意义，至少在短期至中期随访中。因此，需要进一步的研究来确定哪些因素可能导致慢性乙型肝炎患者肾功能损害。
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发表于 2018-4-7 14:29
