本文選題：乙型病毒性肝炎 + 阿德福韋酯�。� 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察阿德福韋酯在抗乙型肝炎病毒治療中對腎功能影響并分析其危險(xiǎn)因素,評估患者在出現(xiàn)阿德福韋酯相關(guān)腎損害后換用或加用替比夫定、恩替卡韋治療對腎功能的改善情況。方法:回顧性分析重慶醫(yī)科大學(xué)第二附屬醫(yī)院門診及住院的慢性乙型病毒性肝病且抗乙型肝炎病毒治療時(shí)間大于2年的患者1007例,按納入標(biāo)準(zhǔn)排除235名患者,最終入組研究對象包括接受阿德福韋酯治療的411例(ADV組),恩替卡韋治療的361例(ETV組),對比兩組患者的基線情況,分析兩組患者出現(xiàn)腎功能損害的差異,采用Kaplan-Meier法分析長期阿德福韋酯治療對患者腎功能維持的影響,用COX回歸分析腎功能損害的相關(guān)因素,卡方檢驗(yàn)分析ADV組出現(xiàn)腎功能損害的患者換用或加用替比夫定、換用恩替卡韋治療后腎功能改善情況及組間差異。結(jié)果:兩組患者年齡、性別、體重基線水平未能完全匹配,但基線的血清肌酐、內(nèi)生肌酐清除率、腎小球?yàn)V過率均有較好一致性;終點(diǎn)時(shí)ADV 組e GFR下降(92.24±25.84 mL.min-1.(1.73 m2)-1)與ETV組(113.14±28.83m L.min-1.(1.73 m2)-1)存在明顯差異,前組3.17例/100人年的發(fā)病率高于后者的1.64例/100人年;單因素及多因素分析后發(fā)現(xiàn)ADV、高血壓、糖尿病、HBe Ag陽性、基線低e GFR水平為腎功能損害危險(xiǎn)因素;ADV組出現(xiàn)腎功能損害的患者換用或加用LDT、換用ETV治療后腎功能均得以改善,三種治療方案間未見明顯差異。結(jié)論:抗乙型肝炎病毒治療中阿德福韋酯較恩替卡韋更容易出現(xiàn)腎功能損害,且可作為獨(dú)立預(yù)測因子,合并有高血壓或/和糖尿病、HBe Ag陽性、潛在腎功能損害的患者更易出現(xiàn)血清肌酐升高、e GFR降低;ADV相關(guān)腎損害患者換用或加用LDT,或換用ETV均能改善腎功能,本研究中暫未觀察到兩者改善腎功能差異。
[Abstract]:Objective: to observe the effect of adefovir ester on renal function and analyze its risk factors in the treatment of hepatitis B virus, and to evaluate the change or addition of tibivudine in patients with adefovir associated renal damage. Improvement of renal function in patients treated with entecavir. Methods: 1007 patients with chronic hepatitis B liver disease treated for more than 2 years in outpatient and inpatient department of the second affiliated Hospital of Chongqing Medical University were analyzed retrospectively, and 235 patients were excluded according to the inclusion criteria. The subjects of the final study included 411 cases of ADV treated with adefovir and 361 cases of ETV treated with entecavir. The baseline conditions of the two groups were compared, and the difference of renal function impairment between the two groups was analyzed. The effects of long-term adefovir dipivoxil therapy on renal function maintenance were analyzed by Kaplan-Meier method, and the related factors of renal function damage were analyzed by COX regression analysis. Chi-square test was used to analyze the patients with renal function impairment in ADV group who were treated with tibivudine or tibivudine. Renal function improvement and difference between groups after replacement of entecavir. Results: the baseline level of age, sex and body weight was not well matched, but the serum creatinine, endogenous creatinine clearance rate and glomerular filtration rate were all consistent in the two groups. There was significant difference between ADV group (92.24 鹵25.84 mL.min-1.(1.73 m2 -1) and ETV group (113.14 鹵28.83m L.min-1.(1.73 m2m2m-1) at the end point, the incidence of GFR in the former group was higher than that in the latter group of 1.64 cases / 100 person-years, the positive rate of HBe Ag in the former group was higher than that in the latter group, the univariate and multivariate analysis showed that ADV, hypertension and diabetes mellitus were HBe Ag positive. Baseline low e GFR level was a risk factor for renal function impairment. The renal function of patients with renal dysfunction was improved after ETV treatment. There was no significant difference among the three treatment regimens. Conclusion: adefovir ester is more likely to develop renal function damage than entecavir in anti-hepatitis B virus therapy, and it can be used as an independent predictor of hypertension or / or diabetes mellitus with HBe Ag positive. Patients with potential renal function impairment were more likely to have elevated serum creatinine (creatinine) and lower serum creatinine (GFR). The patients with ADV-related renal damage could improve their renal function by changing or adding LDTs or changing ETV. No difference was found in the improvement of renal function between the two groups.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R512.62

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