CAJ | 학술논문

目的：两种不同方法评估替比夫定治疗慢性乙型肝炎患者肾小球滤过率的变化。方法回顾性分析2009年9月至2012年9月在复旦大学附属华山医院单用替比夫定600 mg/d 口服治疗的慢性乙型肝炎患者资料。比较基于血清肌酐（Cr）及血清胱抑素 C 计算的肾小球滤过率。统计学处理采用t检验及秩和检验。结果患者共45例，男31例，女14例。患者 Cr 水平在抗病毒治疗前、治疗52周和104周三个时间点分别为（67．00±12．27）、（62．56±10．85）、（61．68±13．31）μmol/L，差异无统计学意义。患者血清胱抑素 C 水平在抗病毒治疗前、治疗52周和104周三个时间点分别为（0．8434±0．1113）、（0．7927±0．1204）、（0．7715±0．0915）mg/L。患者血清胱抑素 C 水平在抗病毒治疗52周和104周均较治疗前下降，差异有统计学意义（t＝2．063，P＝0．0421和t＝3．053，P＝0．0031）。基于血清肌酐计算的肾小球滤过率在抗病毒治疗前、治疗52周和104周三个时间点中位数分别为123．6、123．8、123．7 mL/min/1．73 m2，差异无统计学意义。基于血清胱抑素 C 计算的肾小球滤过率在抗病毒治疗前、52周和104周三个时间点分别为（107．3±15．8）、（113．6±18．7）、（115．1±13．8）mL/min/1．73 m2，基于血清胱抑素 C 计算的肾小球滤过率在104周较治疗前升高，差异有统计学意义（t＝2．284，P＝0．0252）。结论在使用替比夫定治疗慢性乙型肝炎的患者中，肾小球滤过率有改善，基于血清胱抑素 C 计算的肾小球滤过率较基于血清肌酐计算的肾小球滤过率更加敏感。
목적：량충불동방법평고체비부정치료만성을형간염환자신소구려과솔적변화。방법회고성분석2009년9월지2012년9월재복단대학부속화산의원단용체비부정600 mg/d 구복치료적만성을형간염환자자료。비교기우혈청기항（Cr）급혈청광억소 C 계산적신소구려과솔。통계학처리채용t검험급질화검험。결과환자공45례，남31례，녀14례。환자 Cr 수평재항병독치료전、치료52주화104주삼개시간점분별위（67．00±12．27）、（62．56±10．85）、（61．68±13．31）μmol/L，차이무통계학의의。환자혈청광억소 C 수평재항병독치료전、치료52주화104주삼개시간점분별위（0．8434±0．1113）、（0．7927±0．1204）、（0．7715±0．0915）mg/L。환자혈청광억소 C 수평재항병독치료52주화104주균교치료전하강，차이유통계학의의（t＝2．063，P＝0．0421화t＝3．053，P＝0．0031）。기우혈청기항계산적신소구려과솔재항병독치료전、치료52주화104주삼개시간점중위수분별위123．6、123．8、123．7 mL/min/1．73 m2，차이무통계학의의。기우혈청광억소 C 계산적신소구려과솔재항병독치료전、52주화104주삼개시간점분별위 （107．3±15．8）、（113．6±18．7）、（115．1±13．8）mL/min/1．73 m2，기우혈청광억소 C 계산적신소구려과솔재104주교치료전승고，차이유통계학의의（t＝2．284，P＝0．0252）。결론재사용체비부정치료만성을형간염적환자중，신소구려과솔유개선，기우혈청광억소 C 계산적신소구려과솔교기우혈청기항계산적신소구려과솔경가민감。
Objective To compare with two methods of estimating glomerular filtration rate (eGFR)for chronic hepa-titis B (CHB)patients treated with telbivudine.Methods This was a retrospective study,which involved chronic hepatitis B patients with 600 mg telbivudine monotherapy once daily as oral tablets for two years between Sep.2009 and Sep.2012 in Huashan Hospital,Fudan University.Results Forty-five CHB patients were involved in this study,31 were male,and 14 were female.The serum creatinine (SCr)levels were (67.00 ±12.27)μmol/L at baseline,(62.56 ±10.85 )μmol/L at week 52 and (61 .68±13.31)μmol/L at week 104,respectively.There were no significant differences among different time points.Serum cystatin C levels of patients were (0.843 4±0.111 3)mg/L at baseline,(0.792 7±0.120 4)mg/L at week 52 and (0.771 5 ±0.091 5 )mg/L at week 104,respectively.Comparing to baseline,cystatin C levels were significantly decreased at weeks 52 and 104 (t=2.063,P=0.042 1 andt=3.053,P=0.003 1 ,respectively).The median of eGFR by Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI)creatinine equation were 123.6 mL/min/1 .73 m2 at baseline,123.8 mL/min/1 .73 m2 at week 52 and 123.7 mL/min/1 .73 m2 at week 104,respectively,there were no signifi-cant differences among different time points.The mean of eGFR by CKD-EPI cystatin C equation were (107.3 ± 15.80) mL/min/1 .73 m2 at baseline,(113.6±18.70)mL/min/1 .73 m2 at week 52 and (115.1 ±13.84)mL/min/1 .73 m2 at week 104,respectively.However,eGFR by CKD-EPI cystatin C equation was significantly increased at week 104 compared to baseline (t=2.284,P=0.025 2).Conclusion The eGFR was improved in CHB patients treated with telbivudine,and eGFR by CKD-EPI cystatin C equation was more sensitive than that by CKD-EPI creatinine equation.