替诺福韦酯富马酸盐治疗慢性乙型肝炎患者长期肾结局的观

StephenW

J Viral Hepat. 2019 Oct 22. doi: 10.1111/jvh.13222. [Epub ahead of print]
An observational study on long-term renal outcome in patients with chronic hepatitis B treated with tenofovir disoproxil fumarate.
Lim TS1,2,3, Lee JS1,2, Kim BK1,2, Lee HW1,2, Jeon MY1,2, Kim SU1,2, Park JY1,2, Kim DY1,2, Han KH1,2, Ahn SH1,2.
Author information

1
    Department of Internal Medicine, Yonsei University, College of Medicine, Republic of Korea.
2
    Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
3
    Division of Gastroenterology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea.

Abstract

In patients with chronic hepatitis B (CHB), long-term effects of tenofovir disoproxil fumarate (TDF) on renal function have been controversial. This study aimed to analyze the real-world long-term effects of TDF on renal function in Korean patients with CHB. We analyzed a cohort of 640 treatment-naïve patients with CHB who were treated with TDF between May 2012 and December 2015 at Severance Hospital, Seoul, Republic of Korea. The mean age was 48.3 years old, and 59.5% were male. The proportions of hypertension and diabetes mellitus (DM) were 11.6% and 14.2%, respectively, and that of liver cirrhosis was 20.8%. During the 5 year follow up, using a linear mixed model, serum creatinine increased from 0.77 ± 0.01 mg/dL to 0.85 ± 0.02 mg/dL (P<0.001), and eGFR decreased from 102.6 ± 0.6 mL/min/1.73m2 to 93.4 ± 1.4 mL/min/1.73m2 (P<0.001). In subgroup analysis, eGFR was statistically more decreased in patients with age >60 than ≦60 years old (P=0.027), and in patients with diuretic use than without diuretic use (P=0.008). In multivariate analysis, the independent risk factors for eGFR decrease >20% were baseline eGFR <60mL/min/1.73m2 (P=0.034) and the use of diuretics (P<0.001). CHB patients on TDF experienced greater reduction in renal function with age >60 and with diuretic use compared to those without these characteristics. Baseline eGFR <60mL/min/1.73m2 and use of diuretics were independent risk factors of eGFR decline of more than 20% on TDF therapy.

© 2019 John Wiley & Sons Ltd.
KEYWORDS:

Chronic; Drug-Related Side Effects and Adverse Reactions; Hepatitis B; Liver; Renal insufficiency; Tenofovir

PMID:
    31639240
DOI:
    10.1111/jvh.13222

StephenW

J病毒性肝炎。 2019十月22. doi：10.1111 / jvh.13222。 [Epub提前发布]
替诺福韦酯富马酸盐治疗慢性乙型肝炎患者长期肾结局的观察研究。
Lim TS1,2,3，Lee JS1,2，Kim BK1,2，Lee HW1,2，Jeon MY1,2，Kim SU1,2，Park JY1,2，Kim DY1,2，Han KH1,2，Ahn SH1， 2。
作者信息

1个
    韩国延世大学医学院内科学系。
2
    大韩民国首尔遣散医院延世肝脏中心。
3
    大韩民国仁川市Mediplex世宗医院内科消化内科。

抽象

在患有慢性乙型肝炎（CHB）的患者中，替诺福韦富马酸替诺福韦（TDF）对肾功能的长期影响一直存在争议。这项研究旨在分析TDF对韩国CHB患者肾功能的长期影响。我们分析了2012年5月至2015年12月在大韩民国首尔的Severance医院接受TDF治疗的640例初治CHB患者。平均年龄为48.3岁，男性为59.5％。高血压和糖尿病（DM）的比例分别为11.6％和14.2％，而肝硬化的比例为20.8％。在5年的随访中，使用线性混合模型，血清肌酐从0.77±0.01 mg / dL增加至0.85±0.02 mg / dL（P <0.001），eGFR从102.6±0.6 mL / min / 1.73m2降低至93.4±1.4 mL / min / 1.73m2（P <0.001）。在亚组分析中，年龄> 60岁的患者比≤60岁的患者的eGFR下降幅度更大（P = 0.027），并且使用利尿剂的患者比不使用利尿剂的患者（P = 0.008）下降更多。在多变量分析中，eGFR下降> 20％的独立危险因素是基线eGFR <60mL / min / 1.73m2（P = 0.034）和使用利尿剂（P <0.001）。与没有这些特征的患者相比，年龄在60岁以上且使用利尿剂的CHB患者在接受TDF时肾功能的下降更大。基线eGFR <60mL / min / 1.73m2和使用利尿剂是在TDF治疗中eGFR下降超过20％的独立危险因素。

©2019 John Wiley＆Sons Ltd.
关键字：

慢性药物相关的副作用和不良反应；乙型肝炎；肝;肾功能不全;替诺福韦

PMID：
    31639240
DOI：
    10.1111 / jvh.13222