在替诺福韦二吡呋酯治疗期间，没有高甘油三酯血症的患者估算肾小球滤过率部分恢复。
Estimated glomerular filtration rate partially recovered in patients without Hypertriglyceridemia during Tenofovir disoproxil fumarate treatment.
机构信息
Changzhou Clinical Medical College, Nanjing Medical University, Changzhou, Jiangsu Province, China.
Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, Jiangsu Province, China.
出版信息
Ann Med. 2023 Dec;55(1):760-765. doi: 10.1080/07853890.2023.2177725.
BACKGROUND
Decrease in estimated glomerular filtration rate (eGFR) during Tenofovir disoproxil fumarate (TDF) treatment remains a concern, and few patients experience partial recovery of eGFR. This study aimed to investigate the risk factors for eGFR recovery in patients with and without hypertriglyceridemia.
METHODS
A total of 203 patients with chronic HBV infection were prospectively recruited and followed up for three years. Data were collected at baseline, first, second, and third years during TDF treatment.
RESULTS
Most patients achieved normal ALT (80.0% vs. 82.5%) and undetectable HBV DNA (95.0% vs. 95.6%) in both groups ( > 0.05). For patients with hypertriglyceridemia, eGFR and cholesterol did not change significantly during the 3-year follow-up, while triglyceride (TG) decreased significantly in the first year and persisted at a lower level in the subsequent two years. For patients without hypertriglyceridemia, eGFR declined significantly in the first year of treatment, then gradually recovered during the subsequent two years, and eGFR was negatively correlated with TG at the four time points. Fifteen (15/183, 8.2%) patients without hypertriglyceridemia experienced eGFR partial recovery in the third year. Univariate and multivariate analyses showed that baseline eGFR <90 mL/(min·1.73 m) ( < 0.01; 95% CI: 0.019-0.284) and age ( < 0.01; 95% CI: 0.817-0.960) were independent risk factors for eGFR recovery.
CONCLUSION
eGFR partially recovered in patients without hypertriglyceridemia during TDF treatment, and TG regulation might be a useful strategy to hinder renal function decline, although larger, confirmatory studies are necessary to validate our findings.Key messagesFor patients with normal triglyceride, eGFR declined significantly at the first year of TDF treatment, then gradually recovered during the subsequent two years, and eGFR was negatively correlated with TG. Baseline eGFR <90 mL/(min·1.73 m) and age were independent risk factors for eGFR recovery.
背景
替诺福韦酯（TDF）治疗期间估算肾小球滤过率（eGFR）的下降仍然令人担忧，少数患者的 eGFR 部分恢复。本研究旨在探讨伴有和不伴有高甘油三酯血症的患者 eGFR 恢复的危险因素。
方法
前瞻性招募了 203 例慢性乙型肝炎病毒感染患者，并进行了为期 3 年的随访。在 TDF 治疗期间，分别在基线、第 1、2 和 3 年收集数据。
结果
两组患者的大多数患者均达到正常的 ALT（80.0%比 82.5%）和不可检测的 HBV DNA（95.0%比 95.6%）（ > 0.05）。对于伴有高甘油三酯血症的患者，eGFR 和胆固醇在 3 年随访期间没有明显变化，而甘油三酯（TG）在第 1 年显著下降，并在随后的两年中持续保持较低水平。对于不伴有高甘油三酯血症的患者，eGFR 在治疗的第 1 年显著下降，随后在随后的两年中逐渐恢复，并且在四个时间点 eGFR 与 TG 呈负相关。在第 3 年，15 名（15/183，8.2%）不伴有高甘油三酯血症的患者 eGFR 部分恢复。单因素和多因素分析显示，基线 eGFR <90 mL/（min·1.73 m）（ < 0.01；95%CI：0.019-0.284）和年龄（ < 0.01；95%CI：0.817-0.960）是 eGFR 恢复的独立危险因素。
结论
在 TDF 治疗期间，不伴有高甘油三酯血症的患者的 eGFR 部分恢复，调节 TG 可能是阻止肾功能下降的有效策略，尽管需要更大的、确证性研究来验证我们的发现。
关键信息
对于甘油三酯正常的患者，TDF 治疗的第 1 年 eGFR 显著下降，随后在随后的两年中逐渐恢复，并且 eGFR 与 TG 呈负相关。基线 eGFR <90 mL/（min·1.73 m）和年龄是 eGFR 恢复的独立危险因素。
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