丙酚替诺福韦对慢性乙型肝炎初治患者肾功能的影响

Impact of Tenofovir Alafenamide on Renal Function of Treatment-naïve Patients with Chronic Hepatitis B

摘要:

〔摘 要〕 目的：探讨丙酚替诺福韦（TAF）对慢性乙型肝炎（CHB）初治患者肾功能的影响。方法：纳入 2018 年 9 月 至 2020 年 3 月深圳市第三人民医院以 TAF 抗病毒治疗的 62 例 CHB 患者。用线性混合效应模型分析治疗后肾小球滤过率 的变化情况。根据肾小球滤过率是否发生异常分为两组，采用 logistic 回归分析肾小球滤过率发生异常的危险因素。结果： 与治疗前比较，治疗 24 周时肾小球滤过率降低了 5.553 mL·min-1（P ＜ 0.001），48 周时降低了 6.391 mL·min-1（P ＜ 0.001）； 15 例（24.19 %）患者出现肾小球滤过率异常，logistic 回归分析显示基线肾小球滤过率是 TAF 治疗后肾小球滤过率异常的 独立危险因素〔OR = 1.158，95 % CI（1.060，1.266），P = 0.001〕。结论：TAF 治疗 CHB 可影响肾小球滤过率，基线肾 小球滤过率是治疗过程中肾小球滤过率发生异常的独立危险因素。

Abstract:

〔Abstract〕 Objective To investigate the impact of tenofovir alafenamide on renal function with chronic hepatitis B. Methods 62 treatment-na?ve patients with chronic hepatitis B were included from September 2018 to March 2020. The changes of estimated glomerular fi ltration rate were analyzed by linear mixed effect model. Patients were devided into the normal and abnormal estimated glomerular fi ltration rate groups. The risk factors of abnormal estimated glomerular fi ltration rate during treatment with tenofovir alafenamide were analyzed by multivariate logistic regression. Results The estimated glomerular filtration rate decreased by 5.553 mL·min-1 (P < 0.001) at 24-week and 6.391 mL·min-1 (P < 0.001) 48-week treatment. 15 patients (24.19 %) were observed abnormal estimated glomerular fi ltration rate. The multivariate logistic regression analysis showed that the baseline estimated glomerular filtration rate was an independent risk factor for abnormal estimated glomerular filtration rate during the treatment of tenofovir alafenamide [OR = 1.158,95 % CI (1.060,1.266), P = 0.001]. Conclusion TAF treatment of CHB can affect the glomerular filtration rate. The baseline glomerular filtration rate is an independent risk factor for abnormal glomerular fi ltration rate during treatment.