Lee Sangheun, Park Jun Yong, Song Kijun, Kim Do Young, Kim Beom Kyung, Kim Seung Up, Ku Hye Jin, Han Kwang-Hyub, Ahn Sang Hoon
Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Gut Liver. 2015 Nov 23;9(6):776-83. doi: 10.5009/gnl14297.
BACKGROUND/AIMS: The aim of this study was to evaluate the estimated glomerular filtration rate (eGFR) during telbivudine (LdT) versus entecavir (ETV) treatment in chronic hepatitis B (CHB) patients with underlying comorbidities such as diabetes mellitus (DM), hypertension, and cirrhosis.
From 2010 to 2012, 116 CHB patients treated with LdT and 578 treated with ETV were compared in this real-practice cohort. The mean changes in eGFR (Modification of Diet in Renal Disease [MDRD] formula) from baseline to months 6, 12, and 18 were analyzed using a linear mixed model.
In LdT-treated patients, the mean eGFR increased by 7.6% at month 18 compared with the eGFR at baseline (MDRD formula in mL/min/1.73 m(2)). However, in ETV-treated patients, the mean eGFR decreased by 4.1% at month 18 compared with the eGFR at baseline. In the LdT-treated patients with DM, hypertension, cirrhosis or low eGFR <90 mL/min/1.73 m(2), the mean eGFR showed a steady improvement, whereas the mean eGFR was reduced in the same subgroups of ETV-treated patients.
The eGFR gradually increased over time during LdT treatment, especially in patients with mild abnormal eGFR at baseline, and in those with DM, hypertension, and cirrhosis, whereas a reduction in eGFR was seen with ETV treatment.
背景/目的：本研究旨在评估替比夫定（LdT）与恩替卡韦（ETV）治疗合并糖尿病（DM）、高血压和肝硬化等基础疾病的慢性乙型肝炎（CHB）患者期间的估算肾小球滤过率（eGFR）。
在这个实际临床队列中，比较了2010年至2012年期间接受LdT治疗的116例CHB患者和接受ETV治疗的578例患者。使用线性混合模型分析从基线到第6、12和18个月eGFR（肾脏病饮食改良[MDRD]公式）的平均变化。
在接受LdT治疗的患者中，与基线时的eGFR相比，第18个月时平均eGFR增加了7.6%（MDRD公式，单位为mL/min/1.73 m²）。然而，在接受ETV治疗的患者中，与基线时的eGFR相比，第18个月时平均eGFR下降了4.1%。在接受LdT治疗的合并DM、高血压、肝硬化或eGFR<90 mL/min/1.73 m²的患者中，平均eGFR呈稳步改善，而在接受ETV治疗的相同亚组患者中，平均eGFR则降低。
在LdT治疗期间，eGFR随时间逐渐增加，尤其是基线时eGFR轻度异常的患者，以及合并DM、高血压和肝硬化的患者，而ETV治疗则导致eGFR降低。
