替比夫定和阿德福韦酯联合治疗可改善慢性乙型肝炎患者的

StephenW

Medicine (Baltimore). 2018 Nov;97(48):e13430. doi: 10.1097/MD.0000000000013430.
Telbivudine and adefovir dipivoxil combination therapy improves renal function in patients with chronic hepatitis B: A STROBE-compliant article.
Xu Y1, Nie ZW2.
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Abstract

Few studies have addressed the impact of adefovir dipivoxil (ADV)-based combination therapy on the renal function of patients with chronic hepatitis B (CHB). This study evaluated the effects of ADV combined with other antiviral nucleotide analogs (NAs) on renal function of patients with CHB, and analyzed the risk factors for more than 20% reduction of baseline estimated glomerular filtration rate (eGFR).The data of 164 patients with CHB were retrospectively analyzed in this study. Of the 164 patients, 42 received entecavir (ETV) combined with ADV (ETV + ADV group), 68 lamivudine (LAM) combined with ADV (LAM + ADV group), and 54 telbivudine (LDT) combined with ADV (LDT + ADV group). Serum creatinine (SCr) level, eGFR, and proportion of patients with eGFR ≥ 90 mL/min/1.73 m were observed. Also, the independent risk factors for more than 20% reduction of baseline eGFR were analyzed.After 104-week combination therapy, compared with the baseline level, SCr levels were significantly increased in the ETV + ADV group (67 μmol/L vs 73 μmol/L, P = .012) and LAM + ADV group (68 μmol/L vs 79 μmol/L, P = .008), but it was significantly decreased in the LDT + ADV group (69 μmol/L vs 64 μmol/L, P = .023). Compared with the baseline level, eGFR was significantly decreased in the ETV + ADV group (107.8 mL/min/1.73 m vs 96.1 mL/min 1.73/m, P = .004), and LAM + ADV group (105.4 mL/min/1.73 m vs 87.3 mL/min/1.73 m, P = .000), but it was significantly increased in the LDT + ADV group (104.1 mL/min 1.73/m vs 116.2 mL/min/1.73 m,P = .005). The proportion of patients with normal renal function (≥90 mL/min/1.73 m) was significantly higher in the LDT + ADV group than in the ETV + ADV group (P = .002) and LAM + ADV group (P = .001). Multivariate analysis showed that age (P = .035), male (P = .005), baseline eGFR (P < .001), LAM combined with ADV (P < .008), and ETV combined with ADV (P = .03) were independent risk factors for 20% reduction of baseline eGFR.As compared with ETV and ADV combination therapy as well as LAM and ADV combination therapy, LDT and ADV combination therapy can improve eGFR level, so LDT and ADV combination therapy is suitable for the patients with potential renal impairment.

PMID:
    30508954
DOI:
    10.1097/MD.0000000000013430

StephenW

医学（巴尔的摩）。 2018年11月; 97（48）：e13430。 doi：10.1097 / MD.0000000000013430。
替比夫定和阿德福韦酯联合治疗可改善慢性乙型肝炎患者的肾功能：符合STROBE标准的文章。
徐Y1，Nie ZW2。
作者信息
抽象

很少有研究探讨阿德福韦酯（ADV）联合治疗对慢性乙型肝炎（CHB）患者肾功能的影响。本研究评估了ADV联合其他抗病毒核苷酸类似物（NAs）对CHB患者肾功能的影响，并分析了基线估计肾小球滤过率（eGFR）降低20％以上的危险因素.164例患者的数据本研究回顾性分析了CHB患者的临床资料。 164例患者中，42例接受恩替卡韦（ETV）联合ADV（ETV + ADV组），68例拉米夫定（LAM）联合ADV（LAM + ADV组），54例替比夫定（LDT）联合ADV（LDT + ADV组） ）。观察到血清肌酐（SCr）水平，eGFR和eGFR≥90mL/ min / 1.73m的患者比例。此外，分析了基线eGFR降低20％以上的独立危险因素.104周联合治疗后，与基线水平相比，ETV + ADV组SCr水平显着升高（67μmol/ L vs73μmol） / L，P = .012）和LAM + ADV组（68μmol/ L vs79μmol/ L，P = .008），但在LDT + ADV组显着下降（69μmol/ L vs64μmol/ L，P = .023）。与基线水平相比，ETV + ADV组eGFR显着降低（107.8 mL / min / 1.73 m vs 96.1 mL / min 1.73 / m，P = .004），LAM + ADV组（105.4 mL / min / 1.73 m vs 87.3 mL / min / 1.73 m，P = .000），但在LDT + ADV组显着增加（104.1 mL / min 1.73 / m vs 116.2 mL / min / 1.73 m，P = .005） 。 LDT + ADV组肾功能正常（≥90mL/ min / 1.73 m）患者比例显着高于ETV + ADV组（P = .002）和LAM + ADV组（P = .001） ）。多变量分析显示年龄（P = .035），男性（P = .005），基线eGFR（P <.001），LAM联合ADV（P <.008），ETV联合ADV（P = .03） ）与ETV和ADV联合治疗以及LAM和ADV联合治疗相比，LDT和ADV联合治疗可提高eGFR水平，因此LDT和ADV联合治疗适用于基线eGFR降低20％的独立危险因素。有潜在肾功能损害的患者。

结论：
    30508954
DOI：
    10.1097 / MD.0000000000013430