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目的评价核苷(酸)类药物(NUCs)对失代偿期乙型肝炎肝硬化患者肾功能的影响。方法纳入失代偿期乙型肝炎肝硬化患者306例,其中接受抗病毒治疗者中包括拉米夫定(LAM)治疗者39例、阿德福韦(ADV)73例、替比夫定(LDT)34例、恩替卡韦(ETV)48例、LAM联合ADV 41例、LDT联合ADV 25例和未抗病毒治疗对照46例。随访3年。排除失访、随访时间小于3年和对照组中途开始抗病毒治疗者97例,最终209例患者纳入本研究。观察估算的肾小球滤过率(eGFR)、血清肌酐和尿素氮水平变化。结果与对照组比,各抗病毒治疗组1年、2年、3年时eGFR较基线均无明显变化(P>0.05),而LDT、LDT联合ADV组eGFR有逐年升高趋势(P>0.05);本组失代偿期乙型肝炎肝硬化患者在基线时存在轻度肾功能损害者58例(27.8%);在存在轻度肾损伤(基线eGFR<90ml·min~(-1)·1.73m~(-2))的患者,经LDT或LDT联合ADV治疗3年时患者eGFR复常率分别为55.6%和50%;各组患者血清肌酐和尿素氮水平与基线比无显著性差异(P>0.05)。结论 LDT单药或联合ADV可改善失代偿期乙型肝炎肝硬化患者的肾功能。
Objective To evaluate the effect of nucleoside (NUCs) on renal function in patients with decompensated hepatitis B cirrhosis. Methods A total of 306 patients with decompensated hepatitis B cirrhosis were enrolled. Among them, 39 were treated with antiviral therapy including 39 patients with lamivudine (LAM), 73 with adefovir dipivoxil (ADV) 34 with LDT, 48 with entecavir (ETV), 41 with LAM and ADV, 25 with LDT and ADV and 46 with no anti-viral treatment. Followed up for 3 years. Exclusion of lost visits, follow-up time of less than 3 years and control group started 97 cases of antiviral therapy, the final 209 patients included in this study. The estimated glomerular filtration rate (eGFR), serum creatinine and urea nitrogen levels were observed. Results Compared with the control group, eGFR at 1 year, 2 years and 3 years in each antiviral treatment group showed no significant change (P> 0.05), while eGFR in LDT and LDT combined with ADV increased year by year (P> 0.05 ); 58 patients (27.8%) had mild renal impairment at baseline in decompensated hepatitis B cirrhosis patients; mild renal damage (baseline eGFR <90 mL · min -1 1.73m -2), the eGFR recovery rates were 55.6% and 50% respectively after 3-year treatment with LDT or LDT combined with ADV. There was no significant difference in serum creatinine and urea nitrogen levels between baseline and baseline (P> 0.05). Conclusion LDT alone or combined with ADV can improve renal function in patients with decompensated hepatitis B cirrhosis.