發(fā)布時間：2018-06-03 07:00

  本文選題：阿德福韋酯 + 恩替卡韋�。� 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：目的：比較阿德福韋酯(ADV)與恩替卡韋(ETV)治療慢性乙型病毒性肝炎后患者病毒學(xué)、血清學(xué)及腎功能的改變,并分析阿德福韋酯相關(guān)性腎損害的危險因素。 方法：回顧性分析接受阿德福韋酯治療(n=45,其中7例ADV單藥治療,38例聯(lián)合拉米夫定(LAM)抗病毒治療)及恩替卡韋單藥治療(n=45)服藥兩年以上的患者共90例,比較兩組患者接受抗病毒治療后12周、24周、48周、72周、96周乙型肝炎病毒(HBV) DNA陰轉(zhuǎn)率,乙型肝炎病毒e抗原(HBeAg)轉(zhuǎn)換率,谷丙轉(zhuǎn)氨酶(ALT)復(fù)常率、血清肌酐、腎小球率過濾等指標(biāo)的變化情況,并分析ADV組中尿微量蛋白(尿免疫球蛋白IgG、尿微量白蛋白、視黃醇結(jié)合蛋白(RBP)和尿β2微球蛋白)的變化。 結(jié)果：阿德福韋酯組及恩替卡韋組治療96周時乙肝DNA陰轉(zhuǎn)率分別為82.8%和93.3%(p0.05), HBeAg陰轉(zhuǎn)率分別為44%和47.8%(p0.05),ALT復(fù)常率分別為88.9%和93%(p0.05),血肌酐較基線變化值分別為+18.2umol/L和+2.5umol/L (p0.05),腎小球率過濾較基線變化值分別為-14.6ml/min/1.73m2和-1.6ml/min/1.73m2(p0.05);阿德福韋酯治療組中有8名患者出現(xiàn)尿β2微球蛋白異常,9名患者RBP升高；出現(xiàn)尿微量蛋白檢測異常的患者與同組另32名患者在年齡、抗病毒治療時間上有顯著差異(P0.05),與體重、性別、基線eGFR和肌酐無明顯差異。 結(jié)論：恩替卡韋在降HBV DNA及腎臟功能影響方面顯著優(yōu)于阿德福韋酯治療組,兩治療組HBeAg陰轉(zhuǎn)率及ALT復(fù)常率無明顯差異；長期服用阿德福韋酯治療可引起腎功能損害,表現(xiàn)為腎小球濾過率下降,血肌酐上升,尿微量蛋白上升等,其中尿微量蛋白出現(xiàn)更早；阿德福韋酯相關(guān)腎損害可能與患者年齡、服用阿德福韋酯時間有關(guān)。
[Abstract]:Aim: to compare the changes of virology, serology and renal function in patients with chronic hepatitis B treated with adefovir (ADV) and entecavir (ETV), and to analyze the risk factors of renal damage associated with adefovir. Methods: a retrospective analysis was made of 90 patients who received adefovir dipivoxil for more than two years, including 7 patients treated with ADV alone and 38 patients treated with lamivudine) for more than two years. The conversion rate of DNA, HBeAg, alt, creatinine and serum creatinine were compared between the two groups at 12 weeks, 24 weeks and 48 weeks and 72 weeks and 96 weeks, respectively. The changes of urinary microproteins (IgG, albumin, retinol binding protein) and 尾 2 microglobulin (尾 2 microglobulin) in ADV group were analyzed. Results: at 96 weeks after treatment with adefovir dipivoxil and entecavir group, the negative conversion rates of DNA and HBeAg were 82.8% and 93.3%, respectively. The negative conversion rates of HBeAg were 44% and 47.8%, respectively, and the recovery rates of alt were 88.9% and 93%, respectively. The serum creatinine levels were 18.2umol/L and 2.5umol/L p0.05, respectively. The changes of microsphere filtration rate compared with baseline were -14.6 ml / min / 1.73 m2 and -1.6 ml / min / 1.73 m ~ (2) P 0.05, respectively. In the adefovir group, there were 8 patients with abnormal urinary 尾 _ 2-microglobulin and 9 patients with elevated RBP in the adefovir group. There were significant differences in age and time of antiviral therapy between patients with abnormal urine microprotein detection and 32 patients in the same group. There was no significant difference in age, age and time of antiviral therapy between patients with abnormal urine microprotein detection and with body weight, sex, baseline eGFR and creatinine. Conclusion: entecavir is superior to adefovir in decreasing HBV DNA and renal function. There is no significant difference in negative conversion rate of HBeAg and return rate of ALT between the two groups, and long-term treatment with adefovir can cause renal function damage. The results showed that glomerular filtration rate decreased, serum creatinine increased, urine microprotein increased, and urine microprotein appeared earlier. The renal damage associated with adefovir ester may be related to the age of patients and the duration of adefovir administration.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.62

【參考文獻(xiàn)】

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本文編號：1971913