早期肾损伤指标可帮助评估长期使用核苷酸治疗的慢性乙型

StephenW

Early renal injury indicators can help evaluate renal injury in patients with chronic hepatitis B with long-term nucleos(t)ide therapy
Tong-Tong Ji  1 , Ning Tan  1 , Hai-Ying Lu  2 , Xiao-Yuan Xu  1 , Yan-Yan Yu  1
Affiliations
Affiliations

    1
    Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China.
    2
    Department of Infectious Diseases, Peking University First Hospital, Beijing 100034, China. [email protected].

    PMID: 33392311 PMCID: PMC7760448 DOI: 10.12998/wjcc.v8.i24.6306

Abstract

Background: Patients with chronic hepatitis B (CHB) with long-term nucleos(t)ide therapy may experience renal insufficiency. Traditional renal function indicators, such as urine protein, serum urea nitrogen (BUN), and serum creatinine, are normal when early mild lesions occur. Therefore, more sensitive renal function indicators are needed.

Aim: To investigate the significance of early renal injury indicators in evaluating renal injury in patients with CHB with long-term nucleos(t)ide therapy.

Methods: We collected the clinical data of 69 outpatients with CHB at Peking University First Hospital from March 2018 to January 2020 who had been treated with long-term nucleos(t)ide therapy and analyzed the results of early renal injury indicators. Continuous normal distribution data were analyzed by the t-test to determine the difference between two groups. Continuous non-normally distributed data were analyzed by the Mann-Whitney U-test between two groups. The Kruskal-Wallis H test was used to determine the differences among multiple groups. Enumeration data were analyzed by the chi-square test. The related factors of early renal injury indicators were analyzed by logistic regression analysis.

Results: The average treatment duration with nucleos(t)ide analogs of the 69 patients with CHB was 99.7 ± 28.7 mo. The cases of patients with elevated BUN and hypophosphatemia were 6 (8.7%) and 13 (18.8%), respectively; 31 (44.9%) patients had abnormal early renal injury indicators, including 9 patients with abnormal urine microalbumin, 7 patients with abnormal urine immunoglobulin, 6 patients with abnormal urine transferrin, and 19 patients with abnormal α1 microglobulin. There were no significant differences in the mean values of age, sex, BUN, estimated glomerular filtration rate (eGFR), serum uric acid, serum calcium, or serum phosphorus between the two groups of patients with and without early renal injury indicators. However, the mean levels of serum creatinine and urine creatinine, N-acetyl-β-D-glucosidase enzyme, α1 microglobulin, and urine immunoglobulin in the former group of patients were significantly higher than those in the latter group of patients (P < 0.05). The incidence of early renal injury in patients with eGFR ≥ 90, 60-89, and 30-59 mL/(min·1.73 m2) was 36.4% (8/22), 47.6% (20/42), and 60% (3/5), respectively. Logistic regression analysis results showed that gamma-glutamyl transpeptidase [odds ratio (OR) = 1.05 (1.008-1.093), P = 0.020], direct bilirubin [OR = 1.548 (1.111-2.159), P = 0.010], serum creatinine [OR = 1.079 (1.022-1.139), P = 0.006], and age [OR = 0.981 (0.942-1.022), P = 0.357] were independent predictors of early renal injury.

Conclusion: Patients with CHB treated with long-term nucleos(t)ide analog therapy had a high probability of early renal injury, and early renal injury indicators were highly sensitive and could be used to monitor early renal impairment.

Keywords: Chronic hepatitis B; Early renal injury; N-acetyl-β-D-glucosidase enzyme; Nucleos(t)ide analog; Urine immunoglobulin; α1 microglobulin.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

StephenW

早期肾损伤指标可帮助评估长期使用核苷酸治疗的慢性乙型肝炎患者的肾损伤
季同通1，宁潭1，陆海英2，徐小元1，于彦彦1
隶属关系
隶属关系

    1个
    北京大学第一医院感染科，北京100034
    2
    北京大学第一医院感染科，北京100034 [email protected]。

    PMID：33392311 PMCID：PMC7760448 DOI：10.12998 / wjcc.v8.i24.6306

抽象

背景：长期接受核苷酸（t）治疗的慢性乙型肝炎（CHB）患者可能会出现肾功能不全。当早期轻度病变发生时，传统的肾功能指标，如尿蛋白，血清尿素氮（BUN）和血清肌酐正常。因此，需要更敏感的肾功能指标。

目的：探讨早期肾损伤指标在评估长期核苷酸治疗的慢性乙型肝炎患者肾损伤中的意义。

方法：我们收集了北京大学第一医院自2018年3月至2020年1月接受长期核苷酸治疗的69例慢性乙型肝炎门诊患者的临床资料，并分析了早期肾脏损伤指标的结果。通过t检验分析连续正态分布数据，以确定两组之间的差异。两组之间的连续非正态分布数据通过Mann-Whitney U检验进行了分析。使用Kruskal-Wallis H检验确定多个组之间的差异。通过卡方检验分析枚举数据。应用logistic回归分析分析早期肾损伤指标的相关因素。

结果：69例CHB患者的核苷酸（t）类似物平均治疗持续时间为99.7±28.7 mo。 BUN和低磷酸盐血症升高的患者分别为6例（8.7％）和13例（18.8％）； 31例（44.9％）的早期肾损伤指标异常，包括9例尿微量白蛋白异常，7例尿免疫球蛋白异常，6例尿转铁蛋白异常和19例α1微球蛋白异常。在有和没有早期肾损伤指标的两组患者之间，年龄，性别，BUN，估计的肾小球滤过率（eGFR），血清尿酸，血清钙或血清磷的平均值无显着差异。但是，前一组患者的血清肌酐和尿肌酐，N-乙酰基-β-D-葡萄糖苷酶，α1微球蛋白和尿液免疫球蛋白的平均水平显着高于后一组患者（P <0.05 ）。 eGFR≥90、60-89和30-59 mL /（min·1.73 m2）的早期肾损伤发生率为36.4％（8/22），47.6％（20/42）和60％（ 3/5）。 Logistic回归分析结果显示，γ-谷氨酰转肽酶[比值比（OR）= 1.05（1.008-1.093），P = 0.020]，直接胆红素[OR = 1.548（1.111-2.159），P = 0.010]，血清肌酐[OR = 1.079（1.022-1.139），P = 0.006]和年龄[OR = 0.981（0.942-1.022），P = 0.357]是早期肾损伤的独立预测因子。

结论：长期使用核苷酸类似物治疗的慢性乙型肝炎患者发生早期肾损伤的可能性较高，早期肾损伤指标高度敏感，可用于监测早期肾损伤。

关键字：慢性乙型肝炎；早期肾损伤； N-乙酰基-β-D-葡萄糖苷酶；核苷酸类似物;尿液免疫球蛋白； α1微球蛋白。

©The 2020作者。百世登出版集团有限公司出版。保留所有权利。

StephenW

https://www.wjgnet.com/2307-8960/full/v8/i24/6306.htm

lancas

哎~希望能有副作用更低的药物出现~~~