Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Liver Center, Yonsei University Health System, Seoul, Korea.
Gut Liver. 2017 Nov 15;11(6):828-834. doi: 10.5009/gnl16484.
BACKGROUND/AIMS: The renal effects of nucleos(t)ide analogs in patients with chronic hepatitis B are controversial. We aimed to compare the impact of entecavir (ETV) and tenofovir (TDF) on renal function in patients with hepatitis B virus (HBV)-related cirrhosis.
We performed a retrospective cohort study of 235 consecutive treatment-naïve patients with HBV-related cirrhosis who were treated with ETV or TDF between December 2012 and November 2013 at Severance Hospital, Seoul, Korea.
Compensated cirrhosis was noted in 183 patients (ETV 130, TDF 53), and decompensated cirrhosis was noted in 52 patients (ETV 32, TDF 20). There were no significant changes in estimated glomerular filtration rates (eGFR) from baseline in either the ETV- or TDF-treated groups at week 96 (Chronic Kidney Disease Epidemiology Collaboration, ETV -1.68% and TDF -5.03%, p=0.358). Using a multivariate analysis, the significant factors associated with a decrease in eGFR >20% were baseline eGFR, diabetes mellitus (DM), and the use of diuretics. The use of antiviral agents and baseline decompensation were not determined to be significant factors.
In patients with HBV-related cirrhosis, TDF has shown similar renal safety to that of ETV over a 2-year period. Renal function should be closely monitored, especially in patients who exhibit decreasing eGFR, DM, and the use of diuretics.
背景/目的：核苷（酸）类似物在慢性乙型肝炎患者中的肾脏影响存在争议。我们旨在比较恩替卡韦（ETV）和替诺福韦（TDF）对乙型肝炎病毒（HBV）相关肝硬化患者肾功能的影响。
我们对 2012 年 12 月至 2013 年 11 月在韩国首尔 Severance 医院接受 ETV 或 TDF 治疗的 235 例连续初治 HBV 相关肝硬化患者进行了回顾性队列研究。
183 例患者为代偿性肝硬化（ETV 130 例，TDF 53 例），52 例患者为失代偿性肝硬化（ETV 32 例，TDF 20 例）。在第 96 周时，无论是 ETV 治疗组还是 TDF 治疗组，肾小球滤过率估计值（eGFR）均无明显变化（慢性肾脏病流行病学合作组，ETV-1.68%和 TDF-5.03%，p=0.358）。多变量分析显示，与 eGFR 下降>20%相关的显著因素是基线 eGFR、糖尿病（DM）和利尿剂的使用。抗病毒药物的使用和基线失代偿不是确定的显著因素。
在 HBV 相关肝硬化患者中，在 2 年期间，TDF 显示出与 ETV 相似的肾脏安全性。应密切监测肾功能，特别是在 eGFR 下降、DM 和使用利尿剂的患者中。
