替諾福韋和恩替卡韋在肝硬化慢性乙型肝炎頑固性腹水患者

StephenW

Comparison of tenofovir and entecavir in the development of acute kidney injury in cirrhotic chronic hepatitis B patients with refractory ascites

Tsai, Ming-Chaoa,,b; Chang, Kuo-China; Yen, Yi-Haoa; Wu, Cheng-Kuna; Lin, Ming-Tsunga; Hu, Tsung-HuiaAuthor Information
European Journal of Gastroenterology & Hepatology: February 2021 - Volume 32 - Issue 2 - p 208-213
doi: 10.1097/MEG.0000000000001711

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Abstract
Background and aim:

Tenofovir disoproxil fumarate (TDF) and entecavir are effective antiviral medications that are recommended as first-line monotherapies for the treatment of chronic hepatitis B (CHB) infection, including decompensated liver cirrhosis with ascites. Acute kidney injury (AKI) commonly occurs in patients with cirrhosis and ascites. The aim of this study was to compare the development of AKI during TDF and entecavir treatment of CHB patients with cirrhotic refractory ascites.
Methods:

From January 2011 to April 2017, we identified patients who were diagnosed with cirrhosis with refractory ascites and received TDF or entecavir treatments at Kaohsiung Chang Gung Memorial Hospital. AKI was defined as an increase in serum creatinine of more than 0.3 mg/dL or 1.5-fold from baseline. All episodes of AKI were recorded and compared between those who received TDF and entecavir.
Results:

A total of 111 patients were enrolled in this retrospective study, of which 22 patients were treated with TDF and 89 were treated with entecavir. Patients with AKI episodes had a higher proportion of TDF treatment (P = 0.01), male (P = 0.023), hepatocellular carcinoma (P = 0.007), admission (P = 0.045), and mortality (P = 0.018). Logistic regression analysis illustrated that TDF treatment of patients with comorbidity was an independent risk factor for the development of AKI [odds ratio (OR), 3.756; 95% confidence interval (CI), 1.293–10.912; P = 0.015] and hepatorenal syndrome (OR, 7.651; 95% CI, 1.697–34.508; P = 0.008).
Conclusions:

TDF treatment is a risk factor for AKI and HRS development in cirrhotic patients with refractory ascites in comparison with entecavir treatment, especially in patients with comorbidity.
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

StephenW

替諾福韋和恩替卡韋在肝硬化慢性乙型肝炎頑固性腹水患者急性腎損傷發展中的比較

蔡明超，b；張國國顏一豪吳成庫林明俊；胡宗輝作者信息
歐洲胃腸病學和肝病學雜誌：2021年2月-第32卷-第2期-第208-213頁
doi：10.1097 / MEG.0000000000001711

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抽象
背景與目的：

替諾福韋富馬酸替索羅非酯（TDF）和恩替卡韋是有效的抗病毒藥物，推薦作為治療慢性乙型肝炎（CHB）感染（包括腹水失代償性肝硬化）的一線單一療法。肝硬化和腹水患者通常會發生急性腎損傷（AKI）。這項研究的目的是比較在TDF和恩替卡韋治療CHB肝硬化難治性腹水患者中AKI的發展。
方法：

從2011年1月到2017年4月，我們在高雄長庚紀念醫院確定了被診斷為頑固性腹水並接受TDF或恩替卡韋治療的患者。 AKI被定義為血清肌酐比基線增加超過0.3μmg/ dL或1.5倍。記錄所有AKI發作並在接受TDF和恩替卡韋治療的患者之間進行比較。
結果：

這項回顧性研究總共招募了111名患者，其中22例接受TDF治療，89例接受恩替卡韋治療。 AKI發作的患者中TDF治療（P = 0.01），男性（P = 0.023），肝細胞癌（P = 0.007），入院（P（= 0.045）和死亡率（P（= 0.018）的比例更高。 Logistic回歸分析表明，合併有合併症的患者的TDF治療是AKI發生的獨立危險因素[比值比（OR），3.756； 95％置信區間（CI），1.293–10.912； P = 0.015]和肝腎綜合徵（OR，7.651； 95％CI，1.697–34.508； P = 0.008）。
結論：

與恩替卡韋治療相比，TDF治療是肝硬化難治性腹水患者AKI和HRS發生的危險因素，尤其是合併症患者。
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