摘要
目的探究拉米夫定联合阿德福韦酯初始治疗后恩替卡韦单药替代治疗对乙肝肝硬化患者肾脏的影响。方法选取2014年1月至2016年12月该院收治的140例已接受拉米夫定和阿德福韦酯联合治疗1年以上的慢性乙肝肝硬化患者为研究对象,分为观察组和对照组,观察组换用恩替卡韦治疗,对照组继续原方案治疗。随访观察两组尿肾损伤分子-1(KIM-1)、神经导向因子(Netrin-1)水平及肾功能变化。结果随着服药时间的增加,对照组尿KIM-1、Netrin-1水平及血肌酐(Cr)均呈逐渐上升趋势,而观察组变化不明显,两组尿KIM-1、Netrin-1水平及血Cr变化比较,差异有统计学意义(P<0.05)。对照组肾小球滤过率(eGFR)呈逐渐下降趋势,而观察组无明显变化,两组比较差异有统计学意义(P<0.05)。观察组在治疗过程中未见肾损伤,对照组在治疗第6、12、18、24个月的肾损伤率分别为:2.86%、5.71%、10.00%、12.86%,两组从第18个月开始比较,差异有统计学意义(P<0.05)。结论对于初始采用拉米夫定联合阿德福韦酯治疗的慢性乙肝患者,替换恩替卡韦单药治疗能够有效缓解对患者肾功能损害。
Objective To investigate the effects of entecavir monotherapy on kidney in patients with hepatitis B cirrhosis after initial treatment of lamivudine combined with adefovir dipivoxil.Methods A total of 140 patients with chronic hepatitis B cirrhosis who had been treated with lamivudine and adefovir dipivoxil for more than one year from January 2014 to December 2016 were selected,then divided into the observation group and the control group.The observation group changed to be treated with entecavir,while the control group continued to the original regimen.The levels of urinary and renal injury molecule-1(KIM-1),neurotrophic factor-1(Netrin-1)and the renal function were observed.Results The levels of urinary KIM-1,Netrin-1 and serum creatinine(Cr)in the control group increased gradually with the increase of medication time,while those in the observation group did not change significantly.There were significant differences in urinary KIM-1,Netrin-1 and serum Cr levels between the two groups(P<0.05).The glomerular filtration rate(eGFR)in the control group decreased gradually,but there was no significant change in the observation group,with significant difference between the two groups(P<0.05).There was no renal injury in the observation group,while the renal injury rates in the control group were 2.86%,5.71%,10.00%and 12.86%in the 6th,12th,18th and 24th month respectively.From the 18th month,there was significant difference between the two groups(P<0.05).Conclusion For chronic hepatitis B patients who initially treated with lamivudine combined with adefovir dipivoxil,the replacement of entecavir monotherapy could effectively alleviate the impairment of renal function.
作者
陈岚
张蓉
CHEN Lan;ZHANG Rong(Department of Pharmacy,Ruijin Hospital,Shanghai Jiaotong University,Shanghai 200025,China)
出处
《重庆医学》
CAS
2020年第15期2533-2537,共5页
Chongqing medicine
