| 摘要: |
| 目的 观察不同核苷（酸）类似物（NAs）的长期应用对慢性乙型肝炎病毒（HBV）感染肝移植术后患者估算肾小球滤过率（eGFR）的影响。方法 采用回顾性临床队列研究方法，分析2008年8月至2014年10月我院收治的177例服用恩替卡韦（ETV）、替比夫定（LDT）、拉米夫定（LAM）或阿德福韦酯（ADV）治疗的肝移植术后患者的临床资料，分别采用经肾病膳食改良试验（MDRD）公式和慢性肾脏病流行病学协作组（CKD-EPI）公式计算基线时（术后3个月）及术后9、15、21和27个月时各治疗组患者的eGFR。用logistic回归法分析肝移植术后27个月时患者eGFR较基线值变化 ≥ 20%的影响因素。结果 纳入研究的177例患者中， ETV治疗组66例、LDT治疗组21例、LAM治疗组61例、ADV治疗组29例。与患者的基线eGFR相比，LAM治疗组和ADV治疗组患者的eGFR在术后9个月时降低（P<0.05），且在术后27个月内呈进行性降低趋势（P<0.001）；而LDT治疗组患者的eGFR在术后9个月时升高（P<0.05），且在术后27个月内呈进行性升高趋势（P<0.001）；ETV治疗组患者的eGFR在随访期内无显著变化。多因素回归分析显示，LAM或ADV治疗是术后27个月时eGFR较基线值降低 ≥ 20%的独立危险因素（P<0.01），而基线血清尿素氮水平和LDT治疗是eGFR较基线值升高 ≥ 20%的独立预测因素（P<0.01）。结论 肝移植术后患者长期服用LAM或ADV具有潜在的肾脏毒性，而LDT治疗则能改善患者的eGFR，ETV对患者的eGFR无显著影响。 |
| 关键词: 核苷(酸)类似物 估算肾小球滤过率 肝移植 乙型肝炎病毒 |
| DOI：10.16781/j.0258-879x.2017.05.0595 |
| 投稿时间：2017-03-28修订日期：2017-04-25 |
| 基金项目: |
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| Impact of nucleos(t)ide analogues on estimated glomerular filtration rate in post-liver transplantation patients with chronic hepatitis B infection |
| WU Zhi-qin1,XIN Hai-guang1,HANG Xiao-feng1,DING Guo-shan2*,NI Wu1* |
(1. Department of Infectious Disease, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Organ Transplantation, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding authors) |
| Abstract: |
| Objective To explore the impact of long-term administration of different nucleos(t)ide analogues on estimated glomerular filtration rate (eGFR) in post-liver transplantation patients with chronic hepatitis B virus (HBV) infection. Methods In this retrospective clinical cohort study, we included 177 post-liver transplantation patients treated with entecavir (ETV; ETV group), telbivudine (LDT; LDT group), lamivudine (LAM; LAM group) or adefovir dipivoxil (ADV; ADV group) between Aug. 2008 and Oct. 2014 in our hospital, and clinical data of all patients were analyzed. The eGFR levels in post-operation of 3 (baseline), 9, 15, 21 and 27 months were analyzed by modification of diet in renal disease (MDRD) formula and chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Logistic regression method was used to analyze risk factors for ≥ 20% mean change of baseline eGFR level at 27 months after operation. Results Sixty-six of 177 patients received treatment with ETV, 21 with LDT, 61 with LAM and 29 with ADV. Compared with baseline, the eGFR levels of the patients in LAM group and ADV group were significantly decreased at 9 months after liver transplantation (P<0.05), and there was a decreasing tendency during the 27-month follow-up (P<0.001). However, the eGFR level of the patients in LDT group showed a significant increase at 9 months after post-operation (P<0.05), and there was an increasing tencdency during the 27-month follow-up (P<0.001). There was no significant change in eGFR level during the follow-up period in ETV group. Multivariate logistic regression analysis showed that LAM or ADV treatment were independent risk factors for ≥ 20% decrease in the eGFR level at 27 months after operation compared with baseline (P<0.01), and baseline blood urea nitrogen level and LDT treatment were independent predictive factors for ≥ 20% increase in the eGFR level (P<0.01). Conclusion In post-liver transplantation patients, long-course treatment with LAM or ADV may be a potential cause of nephrotoxicity, while LDT treatment can increase the patient's eGFR level, and ETV has no significant influence on the eGFR. |
| Key words: nucleos(t)ide analogue estimated glomerular filtration rate liver transplantation hepatitis B virus |
