Zhang Ye, Zhang Wei-Lu, Pang Xiao-Wen, Wang Lin-Xu, Wei Xin, Huang Chang-Xing, Bai Xue-Fan, Han Shuai, Liu Lin-Na, Lian Jian-Qi
Center for Infectious Diseases, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Rd, Xi'an, China.
Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an, China.
Virol J. 2017 Mar 9;14(1):49. doi: 10.1186/s12985-017-0712-x.
Controversy remains as to whether antiviral agents contribute to renal dysfunction in patients with chronic hepatitis B virus (HBV) infection. Thus, the aim of study was to analyze the changes in renal function of chronic hepatitis B (CHB) patients in response to anti-HBV therapy and the association with treatments.
We performed a retrospective observational cohort study to investigate factors associated with renal function in 249 Chinese CHB patients who were treated with pegylated interferon α-2a (PEG-IFN-α-2a) or nucleos(t)ide analogues for 48 weeks. Changes of estimated glomerular filtration rate (eGFR), which was computed with both the Chronic Kidney Disease Epidemiology Collaboration and the Modification of Diet in Renal Disease formulas, were tested by repeated measures One-way analysis of variance within groups. A linear mixed effects model for repeated measures was also used to evaluate the association between baseline information and eGFR changes over time in all enrolled patients. The model considered the baseline age, sex, HBV DNA, aminotransferase, blood urea nitrogen, treatment group, time, and group-by-time interaction as fixed effects and incorporated random effects for individual subjects.
The eGFR increased in patients given PEG-IFN-α-2a, decreased in patients given adefovir, but remained stable in patients given entecavir. Age and blood urea nitrogen were significant negative predictive factors for eGFR changes.
In real-life study, PEG-IFN-α-2a therapy in CHB patients increased eGFR, thus may associate with renoprotective effects when compared with adefovir or entecavir therapies.
对于抗病毒药物是否会导致慢性乙型肝炎病毒(HBV)感染患者出现肾功能不全,目前仍存在争议。因此,本研究的目的是分析慢性乙型肝炎(CHB)患者在接受抗HBV治疗后肾功能的变化以及与治疗的相关性。
我们进行了一项回顾性观察队列研究,以调查249例接受聚乙二醇干扰素α-2a(PEG-IFN-α-2a)或核苷(酸)类似物治疗48周的中国CHB患者中与肾功能相关的因素。采用慢性肾脏病流行病学协作组公式和肾脏病饮食改良公式计算估算肾小球滤过率(eGFR)的变化,并通过组内重复测量单向方差分析进行检验。还使用重复测量的线性混合效应模型来评估所有入组患者的基线信息与eGFR随时间变化之间的关联。该模型将基线年龄、性别、HBV DNA、转氨酶、血尿素氮、治疗组、时间以及组间时间交互作用视为固定效应,并纳入个体受试者的随机效应。
接受PEG-IFN-α-2a治疗的患者eGFR升高,接受阿德福韦治疗的患者eGFR降低,而接受恩替卡韦治疗的患者eGFR保持稳定。年龄和血尿素氮是eGFR变化的显著负性预测因素。
在实际研究中,CHB患者接受PEG-IFN-α-2a治疗可使eGFR升高,因此与阿德福韦或恩替卡韦治疗相比,可能具有肾脏保护作用。