慢性乙型肝炎患者长期核苷酸类似物治疗的肾毒性水平高于

StephenW

Gut Liver. 2019 May 3. doi: 10.5009/gnl18474. [Epub ahead of print]
Long-term Nucleotide Analogue Treatment Has Higher Levels of Renal Toxicities than Does Entecavir in Patients with Chronic Hepatitis B.
Cho YY1,2, Chang Y1, Nam JY1, Cho H1, Cho EJ1, Lee JH1, Yu SJ1, Yoon JH1, Kim YJ1.
Author information

1
    Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
2
    Department of Internal Medicine, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu Seoul, 06973, Korea.

Abstract
Background/Aims:

Renal toxicity is a concern in patients with chronic hepatitis B taking nucleotide analogues, such as adefovir (ADV) and tenofovir disoproxil fumarate (TDF). We sought to determine the long-term renal effects of nucleotide analogue treatment versus entecavir (ETV) treatment.
Methods:

In this retrospective single-center study, we selected 87 patients who were treated with ADV and subsequently with TDF from June 2008 to December 2013. ETV-treated patients were matched by treatment duration. We analyzed the creatinine increase over 0.5 mg/dL, glomerular filtration rate (GFR) decrease over 25%, phosphorus decrease under 2.0 mg/dL, and dose reduction of antiviral agents.
Results:

The median follow-up period was 60.0 months for both groups. The incidence of liver cirrhosis was higher in the ADV-TDF group than in the ETV group (32.2% vs 74.7%, p<0.01). Creatinine increased in both groups during follow-up, but the difference was not significant (5.7% and 2.3%, p=0.25). In addition, GFR decreased more often in the ADV-TDF group than in the ETV group (31.0% and 14.9%, p=0.02). After multivariate Cox regression analysis, ADV-TDF treatment was significantly associated with a GFR decrease over 25% (hazard ratio, 2.10; 95% confidence interval, 1.08 to 4.10; p=0.03) after adjusting for the baseline GFR decrease.
Conclusions:

Patients taking nucleotide analogues had a significantly higher number of renal events than did those taking ETV. Clinicians should be aware of the development of renal toxicity in this patient population. Further long-term studies are warranted.
KEYWORDS:

Antivirals; Chronic hepatitis B; Nephrotoxicity; Nucleotide analogues; Renal adverse events

PMID:
    31060115
DOI:
    10.5009/gnl18474

StephenW

肠肝。 2019年5月3日doi：10.5009 / gnl18474。 [印刷前的电子版]
慢性乙型肝炎患者长期核苷酸类似物治疗的肾毒性水平高于恩替卡韦。
Cho YY1,2，Chang Y1，Nam JY1，Cho H1，Cho EJ1，Lee JH1，Yu SJ1，Yoon JH1，Kim YJ1。
作者信息

1
首尔国立大学医学院内科和肝脏研究所，101，Daehak-ro，Jongno-gu，Seoul，03080，Korea。
2
韩国东城区Heukseok-102，中央大学医院内科，06973，韩国。

抽象
背景/目的：

慢性乙型肝炎患者服用核苷酸类似物，如阿德福韦（ADV）和替诺福韦地索普西富马酸盐（TDF），肾毒性是一个值得关注的问题。我们试图确定核苷酸类似物治疗与恩替卡韦（ETV）治疗的长期肾脏影响。
方法：

在这项回顾性单中心研究中，我们从2008年6月至2013年12月选择了87例接受ADV治疗并随后接受TDF治疗的患者。经ETV治疗的患者与治疗持续时间相匹配。我们分析了肌酐增加超过0.5 mg / dL，肾小球滤过率（GFR）降低超过25％，磷降低低于2.0 mg / dL，以及抗病毒药物的剂量减少。
结果：

两组的中位随访时间均为60.0个月。 ADV-TDF组肝硬化发生率高于ETV组（32.2％vs 74.7％，p <0.01）。随访期间两组肌酐均增加，但差异不显着（5.7％和2.3％，p = 0.25）。此外，ADV-TDF组的GFR下降幅度大于ETV组（31.0％和14.9％，p = 0.02）。多变量Cox回归分析后，ADV-TDF治疗与GFR下降超过25％显着相关（在调整基线GFR降低后，风险比，2.10; 95％置信区间，1.08至4.10; p = 0.03）。
结论：

服用核苷酸类似物的患者的肾脏事件显着高于服用ETV。临床医生应该了解该患者群体中肾毒性的发展。有必要进一步开展长期研究。
关键词：

抗病毒药物;慢性乙型肝炎;肾毒性;核苷酸类似物;肾脏不良事件

结论：
31060115
DOI：
10.5009 / gnl18474

StephenW

www.gutnliver.org/journal/download_pdf.php?doi=10.5009/gnl18474

小牡丹

亿人想知道的是TAF与恩替卡韦相比，哪个肾脏损害大。砖家叫兽只配吃剩饭。中国的医学家似乎都是酒囊饭袋。

小牡丹

亿人想知道的是TAF与恩替卡韦相比，哪个肾脏损害大。砖家叫兽只配吃剩饭。中国的医学家似乎都是酒囊饭袋。

左罗

ETV比TDF肾毒性小一点，这不需要研究已是早就知道的事情，TAF取代TDF不就是因为这个担心才诞生的嘛， 所以吉利得权威发布说：TAF相对安全。