恩替卡韦
替比夫定
肾功能
医学
替诺福韦
内科学
胃肠病学
乙型肝炎
肝功能
肝细胞癌
肝硬化
肾毒性
泌尿科
慢性肝炎
肾
免疫学
拉米夫定
病毒
人类免疫缺陷病毒(HIV)
作者
Ming‐Chao Tsai,Chia Hsiang Chen,Po‐Lin Tseng,Chao Hung Hung,King-Wah Chiu,J.-H. Wang,Sheng‐Nan Lu,C.-M. Lee,Kuo‐Chin Chang,Yi‐Hao Yen,Meng‐Chih Lin,Yeh‐Pin Chou,Tsung Hui Hu
标识
DOI:10.1016/j.cmi.2015.05.035
摘要
This study aims to assess the nephrotoxicity and efficacy of tenofovir disoproxil fumarate (tenofovir), telbivudine and entecavir. A retrospective study of 587 patients with chronic hepatitis B treated with tenofovir (n = 170), telbivudine (n = 184) and entecavir (n = 233) for at least 1 year. Renal function and efficacy were assessed. The estimated glomerular filtration rate (eGFR) decreased significantly in the tenofovir group after a mean of 17 months treatment (from 92.2 to 85.6 mL/min/1.73 m(2), p < 0.001), but increased in the telbivudine group after a mean of 32 months of treatment (from 86.1 to 95 mL/min/1.73 m(2), p < 0.001). There was no significant change in eGFR in the entecavir group after a mean of 44 months. By multivariate analysis, pre-existing renal insufficiency (p = 0.003), tenofovir (p = 0.007) and diuretic treatment (p = 0.001) were independent predictors for renal function deterioration. Cumulative virological breakthrough was 0% in tenofovir after 2 years, 3.4% in entecavir after 7 years and 22.9% in telbivudine after 5 years. Liver cirrhosis (p = 0.008) and virological breakthrough (p = 0.040) were independently associated with increased risk of hepatocellular carcinoma development. Tenofovir may lead to deterioration in renal function as assessed by serial eGFR measurements. Although telbivudine appeared to be associated with an improvement in eGFR, it was associated with high rates of virological breakthrough, which was an independent risk factor for HCC development. With low rates of virological breakthrough and preservation of renal function, entecavir could be the best choice among these three agents.
科研通智能强力驱动
Strongly Powered by AbleSci AI