| 摘要: |
| 目的 分析替诺福韦在慢性乙型肝炎（CHB）人群中导致肾损伤的高危因素，以期指导临床合理使用该药物。方法 利用Rbase医院合理用药内网系统，检索出2017年5月23日至2020年9月30日在海军军医大学（第二军医大学）第三附属医院安亭院区服用富马酸替诺福韦二吡呋酯（TDF）片的CHB患者共1 278例。按照纳入和排除标准获得197例CHB患者的临床资料，包括对照组（143例）和肾损伤组（54例）。比较两组患者的年龄、性别、合并症（高血压、糖尿病）、基线估算肾小球滤过率（eGFR）、BMI，采用单因素和多因素logistic回归模型分析探讨TDF导致CHB患者肾损伤的高危因素。结果 肾损伤组年龄、合并高血压比例均高于对照组，基线eGFR低于对照组（P均<0.01）。单因素logistic分析显示，年龄、高血压、基线eGFR与TDF导致肾损伤有关（P均<0.01）；多因素logistic分析显示，年龄大（OR=1.98，P=0.002）、高血压（OR=3.94，P=0.001）、基线eGFR低（OR=0.93，P<0.001）是TDF导致肾损伤的独立危险因素，其中年龄≥60岁的CHB患者服用TDF后发生肾损伤的风险是年龄<40岁CHB患者的5.62倍（OR=5.62，P=0.001）。结论 肾功能损害是TDF常见不良反应之一，年龄≥60岁、合并高血压、基线eGFR偏低的CHB患者服用TDF后更容易发生肾损伤。 |
| 关键词: 慢性乙型肝炎 替诺福韦 肾损伤 高危因素 |
| DOI：10.16781/j.CN31-2187/R.20210141 |
| 投稿时间：2021-02-18修订日期：2021-07-30 |
| 基金项目: |
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| High-risk factors of renal injury induced by tenofovir |
| LI Ying1,CHEN Qiu-ting2,ZHOU Yan-ni2,HUANG Chao-jun2,BAO Lei-lei2* |
(1. Department of Pharmacy, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China;
2. Department of Pharmacy, The Third Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the high-risk factors of renal injury induced by tenofovir in population with chronic hepatitis B (CHB), so as to guide the rational use of tenofovir in clinical practice. Methods A total of 1 278 CHB patients who took tenofovir disoproxil fumarate (TDF) tablets in Anting Branch of The Third Affiliated Hospital of Naval Medical University (Second Military Medical University) from May 23, 2017 to Sep. 30, 2020 were selected by the Rbase rational usage of drugs intranet system. According to the inclusion and exclusion criteria, a total of 197 CHB patients were enrolled, including 143 in control group and 54 in renal injury group. The age, gender, comorbidities (hypertension and diabetes), baseline estimated glomerular filtration rate (eGFR) and body mass index (BMI) of patients between the 2 groups were compared. Univariate and multivariate logistic regression models were used to analyze the high-risk factors of renal injury in CHB patients caused by TDF. Results The average age and the proportion of hypertension in the renal injury group were higher than those in the control group, and the baseline eGFR was lower than that in the control group (all P<0.01). Univariate logistic analysis showed that age, hypertension, and baseline eGFR were related to renal injury indued by TDF (all P<0.01). Multivariate logistic analysis showed that older age (odds ratio[OR]=1.98, P=0.002), hypertension (OR=3.94, P=0.001) and lower baseline eGFR (OR=0.93, P<0.001) were independent risk factors for renal injury induced by TDF. After taking TDF, the risk of renal injury in CHB patients aged ≥ 60 years was 5.62 times of that in CHB patients aged <40 years (OR=5.62, P=0.001). Conclusion Renal function impairment is one of the common adverse reactions of TDF. CHB patients aged ≥ 60 years, with hypertension and low baseline eGFR are more likely to suffer from renal injury after taking TDF. |
| Key words: chronic hepatitis B tenofovir renal injury high-risk factors |
