慢性乙型肝炎患者接受口服抗病毒治疗后肾功能的纵向趋势

StephenW

Longitudinal trends in renal function in chronic hepatitis B patients receiving oral antiviral treatment
Prowpanga Udompap
Donghee Kim
Aijaz Ahmed
W. Ray Kim
First published: 29 October 2018
https://doi.org/10.1111/apt.15020

Prowpanga Udompap and Donghee Kim should be considered joint first author.

The Handling Editor for this article was Professor Grace Wong, and it was accepted for publication after full peer‐review.
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Summary
Background

Long term renal safety of antiviral agents against hepatitis B virus (HBV) has been debated.
Aim

To compare longitudinal trends of renal function among HBV mono‐infected patients receiving entecavir (ETV), tenofovir disoproxil fumarate (TDF), and adefovir (ADV) in comparison to untreated subjects.
Methods

A retrospective cohort consisting of 815 patients with chronic HBV infection was constructed. Serial estimated glomerular filtration rate (eGFR) was compared to the expected rate of age‐dependent decline in eGFR, derived from the National Health and Nutrition Examination Survey (NHANES) data. Generalised estimating equations and linear mixed‐effects models were used to compare trends in eGFR (in mL/min/1.73m2 as a “unit”).
Results

In NHANES data (n = 23 051), each year of age was associated with a 0.86 unit decrease in eGFR in subjects without hypertension and 0.96 units with hypertension. The Stanford cohort consisted of patients who received ETV (n = 207), TDF (n = 191), ADV (n = 46) or no therapy (n = 371). After a median follow‐up 4.0 (interquartile range: 1.9‐6.5) years, there was no significant difference in the expected and observed rates of eGFR decline in untreated HBV patients. Patients receiving antiviral treatment experienced steeper reduction in renal function than expected. In the multivariable model, ETV was associated with eGFR loss at 1.81 units per year (P = 0.06, compared to untreated patients). TDF‐ and ADV‐treated patients experienced significantly higher rate of eGFR loss at 2.21 and 2.63 units per year, respectively (both P < 0.01).
Conclusion

In this longitudinal cohort study, HBV patients receiving antiviral therapy, particularly TDF and ADV, experienced more rapid loss in eGFR.

StephenW

慢性乙型肝炎患者接受口服抗病毒治疗后肾功能的纵向趋势
Prowpanga Udompap
Donghee Kim
艾哈兹艾哈迈德
W. Ray Kim
首次发表：2018年10月29日
https://doi.org/10.1111/apt.15020

Prowpanga Udompap和Donghee Kim应被视为联合第一作者。

本文的处理编辑器是Grace Wong教授，经过全面的同行评审后被接受发表。
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摘要
背景

针对乙型肝炎病毒（HBV）的抗病毒剂的长期肾安全性一直存在争议。
目标

比较接受恩替卡韦（ETV），替诺福韦地索普西富马酸盐（TDF）和阿德福韦（ADV）与未治疗受试者的HBV单感染患者的肾功能纵向趋势。
方法

建立了一个由815名慢性HBV感染患者组成的回顾性队列。将序列估计的肾小球滤过率（eGFR）与eGFR的年龄依赖性下降的预期速率进行比较，该数据源自国家健康和营养检查调查（NHANES）数据。广义估计方程和线性混合效应模型用于比较eGFR的趋势（以mL / min / 1.73m2作为“单位”）。
结果

在NHANES数据（n = 23 051）中，每年的年龄与没有高血压的受试者和0.96单位的高血压患者的eGFR降低0.86单位相关。斯坦福大学的队列包括接受ETV（n = 207），TDF（n = 191），ADV（n = 46）或无治疗（n = 371）的患者。在中位随访4.0（四分位数间距：1.9-6.5）年后，未治疗的HBV患者的预期和观察到的eGFR下降率没有显着差异。接受抗病毒治疗的患者肾功能的降低比预期的要大。在多变量模型中，ETV与eGFR损失相关，每年1.81个单位（与未治疗的患者相比，P = 0.06）。 TDF和ADV治疗的患者的eGFR损失率分别显着高于每年2.21和2.63单位（均P <0.01）。
结论

在这项纵向队列研究中，接受抗病毒治疗的HBV患者，特别是TDF和ADV，在eGFR中经历了更快速的丧失。

StephenW

https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15020

纠结哥哥

楼主  早期肝硬化 吃替诺还是干扰素好 防癌的话? 是不是打了干扰素再继续吃替诺 肝癌概率可以降到最低点

hp121

回复 纠结哥哥 的帖子

楼主恐怕不是医生

StephenW

回复 纠结哥哥 的帖子

是的，我不是医生. 就个人而言，我会用替诺阻止和预防纤维化进展. 几乎100％起作用，可以逆转纤维化，从而降低hcc风险.

干扰素治疗需要48周，有很多副作用，可能会对肝脏造成进一步的损害.如果您是HBeAg阳性，年龄较小，ALT较高，您可以考虑干扰素，咨询您的医生

纠结哥哥

原来大三阳 转为小三阳了 现在替诺一年多 早期肝硬化  舅舅有HCC，想最大限度防止HCC 要上干吗？