Xu J, Bao L, Wang Y, Yang L, Li W T, Zhao Z H, Li Y
Department of Infectious Diseases, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Hefei 230001, China.
Zhonghua Gan Zang Bing Za Zhi. 2018 Apr 20;26(4):288-293. doi: 10.3760/cma.j.issn.1007-3418.2018.04.011.
To compare the effect of combined therapy using lamivudine (LAM) plus adefovir (ADV) versus telbivudine (LdT) plus adefovir corresponding to the renal function of CHB patients. A total of 120 patients with chronic hepatitis B were enrolled. According to single daily dosing, they were divided into 4 groups: LdT + ADV group (n = 32), ADV+LdT group (n = 28), LAM + ADV group (n = 38) and ADV + LAM group (n = 22). Hepatorenal function, HBV serological markers, HBV DNA quantification, creatine kinase (CK) and other parameters were examined every 3 months. Serum alanine aminotransferase (ALT) normalization rate, undetectable HBV DNA rate, hepatitis B e antigen (HBeAg) seroconversion rate, level of serum creatinine (CR) and estimated glomerular filtration rate (eGFR) were analyzed at baseline time, and at weeks 24 and 52.Stastical data were analyzed by t- test and analysis of variance, count data using χ (2) test. There was no statistically significant difference between the four groups in terms of ALT normalization rate, HBeAg seroconversion rate, undetectable HBV DNA rate at 24 and 52 weeks. Compared with baseline, at 24 weeks of treatment, there was no significant change in serum creatinine and eGFR in the 4 groups, but after 52 weeks of treatment, serum creatinine decreased in LdT + ADV and ADV + LdT groups and eGFR increased (P < 0.05); Serum creatinine in ADV and ADV + LAM increased, and eGFR was decreased than before (P < 0.05). After treatment, there was no significant difference in renal function between the four groups at 24 weeks, but at week 52, eGFR increased and serum creatinine decreased in LdT + ADV group compared with LAM + ADV group (P < 0.05); ADV + LdT Compared with ADV + LAM group, eGFR increased and serum creatinine decreased (P < 0.05). At 52 weeks of treatment, 5 patients with mildly impaired renal function in the ADV + LdT group [n = 10, eGFR 60-90 ml·min(-1) ·(1.73 m(2))(-1)] returned to normal, and none of the ADV + LAM group (n = 9) returned to normal. For patients with mild impaired renal function, adding LdT combined with ADV can improve renal function compared to that of LAM plus ADV.
比较拉米夫定（LAM）联合阿德福韦（ADV）与替比夫定（LdT）联合阿德福韦对应慢性乙型肝炎（CHB）患者肾功能的治疗效果。共纳入120例慢性乙型肝炎患者。根据每日单次给药，将他们分为4组：LdT + ADV组（n = 32）、ADV+LdT组（n = 28）、LAM + ADV组（n = 38）和ADV + LAM组（n = 22）。每3个月检查肝肾功能、乙肝血清学标志物、乙肝病毒DNA定量、肌酸激酶（CK）等指标。在基线期、第24周和第52周分析血清丙氨酸氨基转移酶（ALT）复常率、乙肝病毒DNA不可测率、乙肝e抗原（HBeAg）血清学转换率、血清肌酐（CR）水平和估计肾小球滤过率（eGFR）。统计数据采用t检验和方差分析，计数资料采用χ²检验。4组在第24周和第52周的ALT复常率、HBeAg血清学转换率、乙肝病毒DNA不可测率方面差异无统计学意义。与基线相比，治疗24周时，4组血清肌酐和eGFR无明显变化，但治疗52周后，LdT + ADV组和ADV + LdT组血清肌酐下降，eGFR升高（P < 0.05）；ADV组和ADV + LAM组血清肌酐升高，eGFR较前降低（P < 0.05）。治疗后，4组在24周时肾功能无明显差异，但在第52周时，LdT + ADV组与LAM + ADV组相比，eGFR升高，血清肌酐下降（P < 0.05）；ADV + LdT组与ADV + LAM组相比，eGFR升高，血清肌酐下降（P < 0.05）。治疗第52周时，ADV + LdT组中5例肾功能轻度受损患者[n = 10，eGFR 60 - 90 ml·min⁻¹·(1.73 m²)⁻¹]恢复正常，ADV + LAM组（n = 9）无1例恢复正常。对于肾功能轻度受损的患者，与LAM联合ADV相比，加用LdT联合ADV可改善肾功能。
