替比夫定与阿德福韦酯治疗对慢性乙型肝炎患者肾脏功能影响的比较

摘要

目的：比较替比夫定和阿德福韦酯治疗前后慢性乙型肝炎（CHB）患者肾功能的变化情况，评估二者对伴有轻度肾功能损害的CHB患者肾功能的影响。方法120例CHB患者分别采用替比夫定（600 mg/d）和阿德福韦酯（10 mg/d）进行抗病毒治疗，比较治疗前基线、治疗24周、治疗52周时患者丙氨酸氨基转移酶（ALT）复常率、乙肝病毒（HBV）DNA转阴率及血清肌酐（CR）、估算肾小球滤过率（eGFR）的变化。结果治疗52周时，替比夫定组和阿德福韦酯组病毒学及生物化学应答情况相似，差异无统计学意义（P>0.05）。治疗52周时与基线相比，替比夫定组CR降低，eGFR升高（P<0.05）；阿德福韦酯组CR升高， eGFR降低（P<0.05）。对于肾功能轻度受损患者，替比夫定组eGFR升高，阿德福韦酯组eGFR降低（P<0.05）。结论替比夫定和阿德福韦酯均有治疗CHB的作用，与阿德福韦酯相比替比夫定还有改善肾脏功能的作用。%Objective To compare renal function changes in chronic hepatitis B(CHB)patients before and after antiviral medicine treatment be-tween telbivudine and adefovir,and assess the impact on renal function in these patients with mild renal impairment. Methods 120 chronic hepati-tis B patients were enrolled for the study,telbivudine and adefovir treatment were carried out in different groups. The normalization rate of alanine aminotransferase(ALT),undetectable rate of HBV DNA,serum creatinine(CR)and estimated glomerular filtration rate(eGFR)were compared on baseline period,24 weeks,and 52 weeks,respectively. Results There was no significant difference between two groups on the index of virology and biochemistry at 52 weeks(P>0.05). Compared with the baseline period,CR decrease and eGFR increase significantly in telbivudine group at 52 weeks(P<0.05),while CR increase and eGFR decrease significantly in adefovir group(P<0.05). In patients with mild renal impairment, eGFR increase significantly in telbivudine group and decrease significantly in adefovir group(P<0.05). Conclusion Both telbivudine and adefo-vir are effective in CHB therapy. Moreover,telbivudine treatment shows a renoprotective effect in patients with CHB.