乙肝相关性肾小球肾炎及优化治疗。

StephenW

Expert Rev Gastroenterol Hepatol. 2020 Jan 17. doi: 10.1080/17474124.2020.1717948. [Epub ahead of print]
Hepatitis B-related glomerulonephritis and optimization of treatment.
Liu Y1, Shi C1, Fan J1, Wang B1, Li G1.
Author information

1
    Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, Shanghai, China.

Abstract

Introduction: Multiple studies have revealed a strong relationship between the development of nephropathy and hepatitis B virus (HBV) infection. The underlying pathogenesis of hepatitis B-related glomerulonephritis (HBV-GN) involves immune complexes, which can be isolated from kidney tissues. Clearance of HBV antigenemia improves renal impairment and proteinuria in HBV-GN patients.Areas covered: In this review, we present our current understanding of the epidemiology, pathogenesis, pathology, diagnosis, and treatment of HBV-GN. We discuss the advantages and disadvantages of oral nucleoside/nucleotide analogs (NAs), and the main pharmaceutical treatment for hepatis B.Expert opinion: Currently, antiviral agents are the main HBV-GN therapeutic agents. Although no randomized controlled clinical trials have compared the efficacy of interferon (IFN) and NA, we suggest IFN treatment for pediatric patients (IFN-α in patients ≥1 year; pegIFN-α in patients ≥3 years) considering treatment duration and absence of resistance. Novel NAs have brought about promising treatment options involving high efficacy viral suppression and low resistance rates. NAs with a high barrier to resistance (e.g. entecavir) are recommended as first-line therapy of HBV-GN. Immunosuppression monotherapy, such as corticosteroids, is of little benefit and potentially harmful to HBV-GN patients due to the possibility of viral reactivation.
KEYWORDS:

antiviral therapy; glomerulonephritis; hepatitis B; immune complex; immunosuppressive therapy

PMID:
    31951758
DOI:
    10.1080/17474124.2020.1717948

StephenW

专家胃肠胃肠肝素。 2020年1月17日。doi：10.1080 / 17474124.2020.1717948。 [Epub提前发行]
乙肝相关性肾小球肾炎及优化治疗。
刘Y1，史C1，范J1，王B1，李G1。
作者信息

1个
    上海交通大学医学院附属新华医院消化内科，上海Kong江路1665号，上海200092

抽象

简介：多项研究表明，肾病的发展与乙型肝炎病毒（HBV）感染之间有着密切的关系。乙型肝炎相关性肾小球肾炎（HBV-GN）的潜在发病机制涉及免疫复合物，可以从肾脏组织中分离出来。清除HBV抗原血症可改善HBV-GN患者的肾功能不全和蛋白尿。覆盖范围：在本综述中，我们介绍了我们目前对HBV-GN的流行病学，发病机理，病理学，诊断和治疗的了解。我们讨论了口服核苷/核苷酸类似物（NAs）的优缺点，以及肝炎B的主要药物治疗。专家意见：目前，抗病毒药是主要的HBV-GN治疗药。尽管尚无随机对照临床试验比较干扰素（IFN）和NA的疗效，但考虑到治疗的持续时间和是否存在干扰素，我们建议对小儿患者进行IFN治疗（≥1年的患者为IFN-α；≥3年的患者为pegIFN-α）。抵抗性。新型NAs带来了有希望的治疗选择，包括高效病毒抑制和低耐药率。建议将耐药性较高的NAs（例如恩替卡韦）作为HBV-GN的一线治疗药物。免疫抑制单一疗法（例如皮质类固醇）获益不大，由于可能会引起病毒再激活，因此对HBV-GN患者可能有害。
关键字：

抗病毒治疗；肾小球肾炎乙型肝炎；免疫复合物免疫抑制疗法

PMID：
    31951758
DOI：
    10.1080 / 17474124.2020.1717948