【摘要】：目的評價替比夫定治療乙型肝炎肝硬化失代償患者的療效及對腎臟功能的影響。方法回顧性分析2012年4月至2015年11月在上海市松江區(qū)中心醫(yī)院感染科就診的失代償期乙型肝炎肝硬化患者72例,給予替比夫定抗病毒治療,在治療后24周、48周觀察血清丙氨酸氨基轉(zhuǎn)移酶(ALT)、血清總膽紅素(TBil)、白蛋白(Alb)、凝血酶原時間(PT)、Child-Pugh積分、腹水、HBV DNA、陰轉(zhuǎn)率及耐藥變異率;比較治療后24周、48周血清肌酐(CR),估算腎小球濾過率(eGFR)較基線的變化情況。計量資料比較采用獨立樣本t檢驗,治療前后比較采用配對t檢驗,計數(shù)資料采用x~2檢驗。結(jié)果治療24周時,血清ALT、TBil、HBV DNA載量均值分別為:46.12 U/L、44.31μmol/L和1.89 lg拷貝/mL,HBV DNA陰轉(zhuǎn)率為75.00%,均較治療前有明顯改善(P0.05)。2例患者出現(xiàn)耐藥變異,但未發(fā)現(xiàn)有腹水消失的病例;隨著治療時間延長至48周,Alb水平和PT均值分別為:34.16 g/L和1 5.09 s,Child-Pugh積分也較治療前進一步明顯改善(P0.05),有3例患者腹水消失且耐藥變異病例增加至5例。治療48周時eGFR及CR分別為:108.48 mL/(min·1.73 m~2)和0.83 mg/dL,均較治療前明顯改善(P(.05),39例基線腎功能輕度受損[eGFR 60~90 mL/(min·1.73 m~2)]患者中,有9例患者(23.08%)上升至eGFR≥90mL/(min·1.73 m~2)。結(jié)論替比夫定治療乙型肝炎肝硬化失代償期患者在有效抑制病毒及改善肝臟儲備功能方面療效肯定,隨著治療時間的延長治療效果更加明顯,但有部分患者出現(xiàn)耐藥變異;替比夫定有改善腎臟功能的作用,對于基線腎功能受損的患者,其腎臟功能可得到一定程度的恢復(fù)。
[Abstract]:Objective to evaluate the efficacy of tibivudine in the treatment of decompensated patients with hepatitis B liver cirrhosis and its effect on renal function. Methods from April 2012 to November 2015, 72 patients with decompensated hepatitis B liver cirrhosis were treated with tibivudine antiviral therapy. Serum alanine aminotransferase (ALT), serum total bilirubin (TBil), albumin (Alb), prothrombin time (PT), Child-Pugh score and ascitic, HBV DNA, were observed 24 weeks and 48 weeks after treatment. Negative conversion rate and drug resistance mutation rate; The changes of renal filtration rate (eGFR) estimated by serum creatine (CR), at 24 weeks and 48 weeks after treatment were compared with those at baseline. Independent sample t test was used to compare the econometric data, pairing t test was used before and after treatment, and x 鈮，

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