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目的比较替比夫定(LdT)与恩替卡韦(ETV)对阿德福韦酯(ADV)相关肾损害的慢性乙型肝炎(CHB)患者肾功能的改善效果并探讨其影响因素。方法阿德福韦酯相关肾损害的CHB或乙型肝炎肝硬化患者41例,分为LdT组(n=21)和ETV组(n=20),停阿德福韦酯后分别给予替比夫定和恩替卡韦抗病毒治疗,疗程均为24周。比较两组治疗前后肾功能的变化情况,并分析其影响因素。结果两组基线估算肾小球滤过率(eGFR)比较差异无统计学意义(P>0.05),治疗24周后两组eGFR较治疗前均有改善,且LdT组改善程度优于ETV组(P均<0.05)。多因素logistic回归分析结果显示,基线eGFR<60 ml·min~(-1)·1.73 m~(-2)和LdT方案是肾功能改善的影响因素(P均<0.05)。结论替比夫定对阿德福韦酯相关肾损害的CHB肾功能改善效果更为明显,且对于基线eGFR<60 ml·min~(-1)·1.73 m~(-2)的患者其改善效果更好。
Objective To compare the effects of telbivudine (LdT) and entecavir (ETV) on renal function in patients with chronic hepatitis B (CHB) associated with adefovir dipivoxil (ADV) -related kidney damage and to explore its influencing factors. Methods 41 patients with CHB or hepatitis B cirrhosis with adefovir dipivoxil-related renal impairment were divided into two groups: LdT group (n = 21) and ETV group (n = 20) Fuding and entecavir antiviral therapy, treatment were 24 weeks. The changes of renal function in both groups before and after treatment were compared and the influencing factors were analyzed. Results There was no significant difference in glomerular filtration rate (eGFR) between the two groups (P> 0.05). After 24 weeks of treatment, the eGFR in both groups improved compared with that before treatment, and the improvement in LdT group was better than that in ETV group P <0.05). Multivariate logistic regression analysis showed that the baseline eGFR <60 ml · min -1 · 1.73 m -2 and LdT regimen were the influencing factors of renal function improvement (all P <0.05). Conclusion The effect of telbivudine on improving renal function of CHB induced by adefovir dipivoxil was more obvious and was improved in patients with baseline eGFR <60 ml · min -1 · 1.73 m -2 Better results.