3年替诺福韦地索普西富马酸盐治疗慢性乙型肝炎患者保留肾

StephenW

Gut Liver. 2018 Oct 18. doi: 10.5009/gnl18183. [Epub ahead of print]
Treatment Outcome and Renal Safety of 3-Year Tenofovir Disoproxil Fumarate Therapy in Chronic Hepatitis B Patients with Preserved Glomerular Filtration Rate.
Min IS1, Lee CH1, Shin IS1, Lee NE1, Son HS1, Kim SB1, Seo SY1, Kim SH1, Kim SW1, Lee SO1, Lee ST1, Kim IH1.
Author information

1
    Department of Internal Medicine, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.

Abstract
Background/Aims:

To investigate the treatment efficacy and renal safety of long-term tenofovir disoproxil fumarate (TDF) therapy in chronic hepatitis B (CHB) patients with preserved renal function.
Methods:

The medical records of 919 CHB patients who were treated with TDF therapy were reviewed. All patients had preserved renal function with an estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. The therapeutic efficacy and renal safety, in addition to their associated factors, were assessed using clinical and laboratory parameters.
Results:

A total of 426 patients (184 treatment-naïve and 242 treatment-experienced) were included for analysis. A virologic response (VR) was defined as achieving an undetectable serum hepatitis B virus (HBV) DNA level, and the overall VR was 74.9%, 86.7%, and 89.4% at the 1-year, 2-year, and 3-year follow-ups, respectively. The treatment outcome was favorable in both the treatment-naïve and treatment-experienced groups, without significant differences between the two groups. Achieving a VR was not influenced by previous treatment experience, TDF combination therapy, or antiviral resistance. In a multivariate analysis, being hepatitis B e antigen positive at baseline and having a serum HBV DNA level ≥ 2,000 IU/mL at 12 months were associated with lower VR rates during the long-term TDF therapy. The overall renal impairment was 2.9%, 1.8%, and 1.7% at the 1-year, 2-year, and 3-year follow-ups, respectively. With regard to renal safety, underlying diabetes mellitus (DM) and an initial eGFR of 60 to 89 mL/min/1.73 m2 were significant independent predictors of renal impairment.
Conclusions:

TDF therapy appears to be an effective treatment option for CHB patients with a preserved GFR. However, patients with underlying DM and initial mild renal dysfunction (eGFR, 60 to 89 mL/min/1.73 m2) have an increased risk of renal impairment.
KEYWORDS:

Antiviral agents; Chronic hepatitis B; Renal insufficiency; Tenofovir; Treatment outcome

PMID:
    30400723
DOI:
    10.5009/gnl18183

StephenW

肠肝。 2018年10月18日doi：10.5009 / gnl18183。 [提前打印]
3年替诺福韦地索普西富马酸盐治疗慢性乙型肝炎患者保留肾小球滤过率的治疗结果和肾脏安全性。
Min IS1，Lee CH1，Shin IS1，Lee NE1，Son HS1，Kim SB1，Seo SY1，Kim SH1，Kim SW1，Lee SO1，Lee ST1，Kim IH1。
作者信息

1
    全北大学医学院内科，全北大学临床医学研究所 - 韩国全北全州全国大学医院生物医学研究所。

抽象
背景/目的：

调查长期替诺福韦地索普西富马酸盐（TDF）治疗慢性乙型肝炎（CHB）肾功能保留患者的治疗效果和肾脏安全性。
方法：

回顾了919名接受TDF治疗的CHB患者的医疗记录。所有患者均保持肾功能，估计肾小球滤过率（eGFR）至少为60 mL / min / 1.73 m2。使用临床和实验室参数评估治疗功效和肾安全性以及它们的相关因素。
结果：

共纳入426名患者（184名初治患者和242名经历过治疗的患者）进行分析。病毒学应答（VR）被定义为实现不可检测的血清乙型肝炎病毒（HBV）DNA水平，并且在1年，2年和3年时整体VR为74.9％，86.7％和89.4％分别是后续行动。治疗结果在初治治疗组和治疗组中都是有利的，两组之间没有显着差异。实现VR不受先前治疗经验，TDF联合治疗或抗病毒抗性的影响。在多变量分析中，在基线时乙型肝炎e抗原阳性且12个月时血清HBV DNA水平≥2000IU/ mL与长期TDF治疗期间的VR率降低相关。在1年，2年和3年随访中，总体肾损害分别为2.9％，1.8％和1.7％。关于肾安全性，潜在的糖尿病（DM）和60至89mL / min / 1.73m 2的初始eGFR是肾损伤的显着独立预测因子。
结论：

对于保留GFR的CHB患者，TDF治疗似乎是一种有效的治疗选择。然而，患有潜在DM和初始轻度肾功能不全（eGFR，60至89 mL / min / 1.73 m2）的患者肾功能受损的风险增加。
关键词：

抗病毒药;慢性乙型肝炎;肾功能不全;替诺福韦;治疗结果

结论：
    30400723
DOI：
    10.5009 / gnl18183

StephenW

http://www.gutnliver.org/journal ... oi=10.5009/gnl18183