Asian Pacific Liver Center, Saint Vincent Medical Center, Los Angeles, CA, USA.
Dig Dis Sci. 2015 Feb;60(2):566-72. doi: 10.1007/s10620-014-3363-4. Epub 2014 Sep 20.
Increased risk of defective urinary phosphate reabsorption and osteoporosis has been reported in HIV and chronic hepatitis B (CHB) patients treated with tenofovir disoproxil fumarate (TDF).
Goals of this study were to evaluate the prevalence of renal phosphate wasting and abnormal bone mineral density in CHB patients taking TDF compared to CHB patients treated with entecavir (ETV) and untreated CHB patients.
This is a cross-sectional study of 146 consecutive Asian-American CHB patients who were treatment naïve (n = 60) or treated with either TDF (n = 42) or ETV (n = 44). Proximal tubular handling of phosphate was assessed by the maximal rate of tubular reabsorption of phosphate (TmPO4) divided by glomerular filtration rate (GFR) (TmPO4/GFR). Bone mineral density (BMD) was measured using dual X-ray absorptiometry.
TmPO4/GFR was similar among CHB patients treated with TDF compared to untreated patients and patients taking ETV. However, among patients treated with ≥18 months of TDF or ETV, prevalence of abnormal TmPO4/GFR was higher among patients treated with TDF compared to ETV (48.5 % (16/33) vs. 12.5 % (3/24), p = 0.005). Overall prevalence of osteoporosis in this cohort of CHB patients was 14 %, with no significant difference between the three groups. Renal phosphate handling did not correlate with osteoporosis.
Chronic hepatitis B patients treated with ≥18 months of TDF experienced an increased risk of proximal tubular dysfunction. TDF did not increase the risk of osteoporosis. Longitudinal studies are needed to confirm these findings.
有报道称，接受富马酸替诺福韦二吡呋酯（TDF）治疗的 HIV 和慢性乙型肝炎（CHB）患者存在尿磷酸盐重吸收缺陷和骨质疏松的风险增加。
本研究旨在评估与接受恩替卡韦（ETV）治疗的 CHB 患者和未接受治疗的 CHB 患者相比，接受 TDF 治疗的 CHB 患者中磷酸盐排泄增加和骨矿物质密度异常的发生率。
这是一项针对 146 例连续的亚裔美国 CHB 患者的横断面研究，这些患者为初治患者（n=60）或接受 TDF（n=42）或 ETV（n=44）治疗。通过磷酸盐最大重吸收率（TmPO4）与肾小球滤过率（GFR）的比值（TmPO4/GFR）评估近端肾小管对磷酸盐的处理。使用双能 X 线吸收法测量骨矿物质密度（BMD）。
与未接受治疗的患者和接受 ETV 治疗的患者相比，接受 TDF 治疗的 CHB 患者的 TmPO4/GFR 相似。然而，在接受 TDF 或 ETV 治疗≥18 个月的患者中，与接受 ETV 治疗的患者相比，接受 TDF 治疗的患者中异常 TmPO4/GFR 的发生率更高（48.5%（16/33）比 12.5%（3/24），p=0.005）。在这组 CHB 患者中，骨质疏松的总患病率为 14%，三组之间无显著差异。肾脏磷酸盐处理与骨质疏松症无关。
接受≥18 个月 TDF 治疗的慢性乙型肝炎患者出现近端肾小管功能障碍的风险增加。TDF 并未增加骨质疏松症的风险。需要进行纵向研究来证实这些发现。
