替比夫定治療不同救治策略的乙肝患者乙肝表面抗原動力學

StephenW

Kinetics of hepatitis B surface antigen and estimated glomerular filtration rate in telbivudine-treated hepatitis B patients with different rescue strategies
Hsien-Chung Yu  1   2   3   4   5 , Kung-Hung Lin  1   2   3 , Feng-Woei Tsay  3   4 , Tzung-Jiun Tsai  3   4 , Pin-Chieh Wu  1   2   6 , Yu-Hsun Chen  1   7 , Yan-Hua Chen  1   2   3
Affiliations
Affiliations

    1
    Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
    2
    Department of Nursing, Meiho University, Pingtung, Taiwan.
    3
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
    4
    Chung Shan Medical University, Taichung, Taiwan.
    5
    Institute of Health Care Management, Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan.
    6
    Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
    7
    Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

    PMID: 32785260 DOI: 10.1371/journal.pone.0237586

Abstract

This study investigated the kinetics of estimated glomerular filtration rate (eGFR) and quantitative hepatitis B surface antigen (qHBsAg) in telbivudine (LdT)-treated chronic hepatitis B (CHB) patients whose treatment was subsequently adjusted with the adding on adefovir or by switching to tenofovir disoproxil fumarate (TDF) as rescue. Of 295 CHB patients initially treated with LdT, 102 of them who subsequently receiving either adding-on adefovir (group A, n = 58) or switching to TDF (group B, n = 44) for more than 24 months were enrolled. Serial eGFR and qHBsAg levels (3 to 6 monthly) in both LdT monotherapy and rescue therapy periods were analyzed retrospectively. Subsequent decline of qHBsAg especially in rescue therapy period were noted (p<0.001 and p = 0.068 in group A and B). However, patients in group B achieved a significant increase of eGFR (p = 0.010) in LdT monotherapy period but had a significant decline of eGFR (p<0.001) in rescue therapy period. In contrast, patients in group A maintained eGFR levels in both periods. Meanwhile, switch to TDF (hazard ratio: 3.036; 95% confidence interval: 1.040-8.861; p = 0.042) was the sole factor related to the decrease of eGFR>20% from baseline. Both rescue therapies achieved subsequent declines of qHBsAg over time but caused different changes in eGFR. LdT-based rescue therapy maintained eGFR but TDF switching therapy descended eGFR. Therefore, it is essential to monitor patient's renal function intensively when switching from LdT to TDF as a rescue strategy.

StephenW

替比夫定治療不同救治策略的乙肝患者乙肝表面抗原動力學和估計腎小球濾過率
於顯中1 2 3 4 5，林恭紅1 2 3，馮鳳儀3 4，蔡宗俊3 4，吳品傑1 2 6，陳玉勳1 7，燕華陳1 2 3
隸屬關係
隸屬關係

    1個
    台灣高雄市高雄榮民總醫院健康管理中心。
    2
    Meiho大學護理系，台灣屏東。
    3
    台灣高雄市高雄榮民總醫院消化內科，消化內科。
    4
    台灣台中中山醫科大學。
    5
    國立中山大學商務管理系衛生管理研究所，台灣高雄。
    6
    台灣高雄市高雄榮民總醫院家庭醫學科。
    7
    台灣高雄市高雄榮民總醫院外科大腸外科。

    PMID：32785260 DOI：10.1371 / journal.pone.0237586

抽象

這項研究調查了替比夫定（LdT）治療的慢性乙型肝炎（CHB）患者的估計腎小球濾過率（eGFR）和定量乙型肝炎表面抗原（qHBsAg）的動力學，隨後對其治療進行了調整，增加阿德福韋或改用替諾福韋富馬酸替索羅非酯（TDF）搶救。在295名最初接受LdT治療的CHB患者中，其中102名隨後接受了附加阿德福韋（A組，n = 58）或改用TDF（B組，n = 44）超過24個月。回顧性分析LdT單藥治療和搶救治療期間的連續eGFR和qHBsAg水平（每月3至6個）。觀察到隨後的qHBsAg下降，尤其是在搶救治療期間（A和B組，p <0.001，p = 0.068）。但是，B組患者在LdT單藥治療期間eGFR顯著增加（p = 0.010），而在搶救治療期間eGFR顯著下降（p <0.001）。相反，A組患者在兩個時期均維持eGFR水平。同時，轉換為TDF（危險比：3.036； 95％置信區間：1.040-8.861； p = 0.042）是與eGFR較基線下降> 20％有關的唯一因素。隨著時間的推移，兩種急救療法均使qHBsAg下降，但引起eGFR的變化。基於LdT的搶救療法維持eGFR，但TDF轉換療法降低了eGFR。因此，當從LdT切換到TDF時，作為救援策略，必須集中監測患者的腎功能。

StephenW

https://journals.plos.org/ploson ... ournal.pone.0237586