转换为恩替卡韦乙型肝炎患者在替诺福韦期间发生肾功能障

StephenW

Liver Int. 2018 Dec 7. doi: 10.1111/liv.14017. [Epub ahead of print]
Effectiveness and safety of switching to entecavir hepatitis B patients developing kidney dysfunction during tenofovir.
Viganò M1, Loglio A2, Labanca S1, Zaltron S3, Castelli F3, Andreone P4, Messina V5, Ganga R6, Coppola N7, Marrone A8, Russello M9, Marzano A10, Tucci A10, Taliani G11, Fasano M12, Fagiuoli S13, Villa E14, Bronte F15, Santantonio T16, Brancaccio G17, Occhipinti V1, Facchetti F2, Grossi G2, Rumi M1, Lampertico P2.
Author information

1
    U.O. Epatologia, Ospedale San Giuseppe, University of Milan, Milan, Italy.
2
    CRC "A. M. e A. Migliavacca", Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
3
    Clinica Malattie Infettive e Tropicali. Spedali Civili Brescia, University of Brescia, Brescia, Italy.
4
    Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy.
5
    U.O.C. Malattie Infettive, A.O. S. Anna e S. Sebastiano, Caserta, Italy.
6
    S.C Medicina Interna, Ospedale S. Michele A.O. Brotzu, Cagliari, Italy.
7
    Malattie Infettive, Second University of Naples, Dipartimento Salute Mentale e Medicina Preventiva, Naples, Italy.
8
    Dipartimento di Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, Luigi Vanvitelli University of CampaniaNaples, Italy.
9
    U.O.S. Epatologia e Malattie Gastroenteriche dell'A.R.N.A.S. Garibaldi-Nesima, Catania, Italy.
10
    U.O. Gastroenterologia Universitaria, Ospedale San Giovanni Battista, Città della Salute e della Scienza di Torino, Turin, Italy.
11
    Unità di Malattie Infettive e Tropicali, Dipartimento di Medicina Clinica, Sapienza University, Rome, Italy.
12
    UOC Malattie Infettive Ospedale F. Fallacara, Triggiano, Italy.
13
    Dipartimento di Gastroenterologia, Epatologia e Trapianto di Fegato, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
14
    Divisione di Gastroenterologia, AOU Policlinico di Modena, University of Modena e Reggio Emilia, Modena, Italy.
15
    Unità di Gastroenterologia ed Epatologia, DiBiMIS, University of Palermo, Palermo, Italy.
16
    Dipartimento di Medicina Clinica e Sperimentale, University of Foggia, Foggia, Italy.
17
    Malattie Infettive, University of Padua, Padua, Italy.

Abstract
BACKGROUND & AIMS:

Tenofovir disoproxil fumarate (TDF) is recommended for chronic hepatitis B (CHB) treatment, but it may induce kidney dysfunction whose management is not yet known. This Italian, multicentre, retrospective study aimed to assess the efficacy and safety of switching to entecavir (ETV) patients who developed TDF-associated glomerular and/or tubular dysfunction.
METHODS:

103 TDF-treated patients were included: age 64 years, 83% male, 49% cirrhotics, 98% with undetectable HBV DNA, 47% with previous lamivudine resistance (LMV-R), and 71% previously treated with adefovir. Twenty-nine (28%) were switched to ETV because estimated glomerular filtration rate (eGFRMDRD ) was <60 mL/min, 37 (36%) because blood phosphate (P) levels were <2.5 mg/dL, and 37 (36%) for both reasons. Kidney, liver and virological parameters were recorded every four months thereafter.
RESULTS:

During 46 (4-115) months of ETV treatment, all patients' renal parameters significantly improved: creatinine from 1.30 to 1.10 mg/dL (p<0.0001), eGFRMDRD from 54 to 65 mL/min (p=0.002), P from 2.2 to 2.6 mg/dL (p<0.0001), and maximal tubule phosphate reabsorption (TmPO4/eGFR) from 0.47 to 0.62 mmol/L (p<0.0001). Thirteen patients (52%) improved their eGFRMDRD class, P levels were normalised in 13 (35%), and 8 (22%) showed improvements in both parameters. Viral suppression was maintained in all but five patients (5%), all of whom had been LMV-R. The 5-year cumulative probability of ETV-R was 0% in LMV-naïve patients, and 11% in LMV-R patients (p=0.018).
CONCLUSIONS:

ETV is an effective and safe rescue strategy for CHB patients who develop renal dysfunction during long-term TDF treatment. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

Hepatitis B virus; liver; liver function tests; renal dysfunction; viral hepatitis

PMID:
    30525275
DOI:
    10.1111/liv.14017

StephenW

肝脏国际2018年12月7日doi：10.1111 / liv.14017。 [提前打印]
转换为恩替卡韦乙型肝炎患者在替诺福韦期间发生肾功能障碍的有效性和安全性。
ViganòM1，Loglio A2，Labanca S1，Zaltron S3，Castelli F3，Andreone P4，墨西拿V5，Ganga R6，Coppola N7，Marrone A8，Russello M9，Marzano A10，Tucci A10，Taliani G11，Fasano M12，Fagiuoli S13，Villa E14 ，Bronte F15，Santantonio T16，Brancaccio G17，Occhipinti V1，Facchetti F2，Grossi G2，Rumi M1，Lampertico P2。
作者信息

1
    U.O. Epatologia，Ospedale San Giuseppe，米兰大学，米兰，意大利。
2
    CRC“A. M. e A. Migliavacca”，Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico，意大利米兰米兰大学消化内科和肝病学系。
3
    Clinica Malattie Infettive e Tropicali。 Spedali Civili Brescia，布雷西亚大学，布雷西亚，意大利。
4
    Dipartimento di Scienze Mediche e Chirurgiche，博洛尼亚大学，意大利博洛尼亚。
五
    U.O.C. Malattie Infettive，A.O。 S. Anna e S. Sebastiano，意大利卡塞塔。
6
    S.C Medicina Interna，Ospedale S. Michele A.O.布罗兹，卡利亚里，意大利。
7
    Malattie Infettive，第二大学那不勒斯，Dipartimento Salute Mentale e Medicina Preventiva，那不勒斯，意大利。
8
    Dipartimento di Scienze Mediche，Chirurgiche，Neurologiche，Metaboliche e dell'Invecchiamento，Luigi Vanvitelli University of CampaniaNaples，Italy。
9
    U.O.S. Epatologia e Malattie Gastroenteriche dell'A.R.N.SA。加里波第 - 尼西马，卡塔尼亚，意大利。
10
    U.O. Gastroenterologia Universitaria，Ospedale San Giovanni Battista，CittàdellaSalute e della Scienza di Torino，都灵，意大利。
11
    UnitàdiMalattie Infettive e Tropicali，Dipartimento di Medicina Clinica，Sapienza University，Rome，Italy。
12
    UOC Malattie Infettive Ospedale F. Fallacara，Triggiano，意大利。
13
    Dipartimento di Gastroenterologia，Epatologia e Trapianto di Fegato，Ospedale Papa Giovanni XXIII，Bergamo，Italy。
14
    Divisione di Gastroenterologia，AOU Policlinico di Modena，Modena e Reggio Emilia，意大利摩德纳。
15
    UnitàdiGastroenterologia ed Epatologia，DiBiMIS，Palermo大学，巴勒莫，意大利。
16
    Dipartimento di Medicina Clinica e Sperimentale，Foggia大学，Foggia，意大利。
17
    Malattie Infettive，帕多瓦大学，帕多瓦，意大利。

抽象
背景与目的：

替诺福韦地索普西富马酸盐（TDF）被推荐用于慢性乙型肝炎（CHB）治疗，但它可能诱发肾功能不全，其管理尚不清楚。这项意大利，多中心，回顾性研究旨在评估转换为发生TDF相关肾小球和/或肾小管功能障碍的恩替卡韦（ETV）患者的疗效和安全性。
方法：

纳入TDF治疗的患者103例：年龄64岁，男性83％，肝硬化49％，98％HBV DNA检测不到，47％有拉米夫定耐药（LMV-R），71％用阿德福韦治疗。 29例（28％）转为ETV，因为估计肾小球滤过率（eGFRMDRD）<60 mL / min，37（36％），因为血磷（P）水平<2.5 mg / dL，37（36％） ）两个原因。此后每四个月记录肾脏，肝脏和病毒学参数。
结果：

在ETV治疗46（4-115）个月期间，所有患者的肾脏参数均显着改善：肌酐从1.30到1.10 mg / dL（p <0.0001），eGFRMDRD从54到65 mL / min（p = 0.002），P来自2.2至2.6 mg / dL（p <0.0001），最大小管磷酸盐重吸收（TmPO4 / eGFR）为0.47至0.62 mmol / L（p <0.0001）。 13名患者（52％）改善了他们的eGFRMDRD类别，P水平标准化为13（35％），8名（22％）显示两个参数都有所改善。除了5名患者（5％）外，其他所有患者均维持病毒抑制，所有患者均为LMV-R。在LMV初治患者中，ETV-R的5年累积概率为0％，在LMV-R患者中为11％（p = 0.018）。
结论：

对于在长期TDF治疗期间发生肾功能障碍的CHB患者，ETV是一种有效且安全的抢救策略。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

乙型肝炎病毒;肝;肝功能检查;肾功能不全;病毒性肝炎

结论：
    30525275
DOI：
    10.1111 / liv.14017