丙酚替诺福韦联合福辛普利治疗乙型肝炎相关性IgA肾病疗效分析

肝脏 ›› 2021, Vol. 26 ›› Issue (2): 136-139.

丙酚替诺福韦联合福辛普利治疗乙型肝炎相关性IgA肾病疗效分析

赖华梅, 王俊, 王鸿

202150 上海交通大学医学院附属新华医院崇明分院消化内科(赖华梅,王鸿),教学办公室(王俊)

收稿日期:2020-09-22 出版日期:2021-02-28 发布日期:2021-03-28
通讯作者: 王鸿

Efficacy of propofenofovir combined with fosinopril in the treatment of hepatitis B-related IgA nephropathy

LAI Hua-mei¹, WANG Jun², WANG Hong¹

1. Department of Digestive Medicine, Chongming Hospital, School of Medicine, Shanghai Jiaotong University Shanghai 202150;
2. Teaching Office, Chongming Branch, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University

Received:2020-09-22 Online:2021-02-28 Published:2021-03-28

摘要/Abstract

摘要： 目的研究丙酚替诺福韦联合福辛普利对比恩替卡韦联合福辛普利治疗乙型肝炎相关性IgA肾病疗效差异。方法纳入2019年4月至2020年1月在上海新华医院崇明分院就诊的乙型肝炎相关性IgA肾病患者75例。将患者分为丙酚替诺福韦联合福辛普利组(A组)35例,恩替卡韦联合福辛普利组(B组)37例,比较两组连续用药24周的疗效。结果治疗12周后,二组患者的24小时尿蛋白定量(0.45±0.15比0.69±0.17,t=-6.208,P<0.01)、血清白蛋白(t=2.799,P<0.01)、HBV DNA阳性例数占比(20%比43.2%,χ²=4.470,P=0.035)差异有统计学意义,而收缩压、舒张压、SCr、尿潜血＞2+例数占比和尿素氮、Lee分级III级及以上例数占比差异无统计学意义。治疗24周后,二组患者的24小时尿蛋白定量(0.13±0.06 比0.23±0.08,t=-5.565,P<0.01)、血清白蛋白(t=4.673,P<0.01)、收缩压(t=-5.704,P<0.01)、舒张压(t=-2.657,P=0.010)、SCr(69.76±22.00比84.08±18.76,t=-2.986,P<0.01)、HBV DNA阳性例数占比(8.6%比 27%,χ²=-4.141,P=0.042)、Lee分级Ⅲ级及以上例数占比(8.6%比29.7%,χ²=3.878,P=0.049)差异有统计学意义,而尿潜血(＞2+)人数占比和尿素氮两者对比差异无统计学意义。结论丙酚替诺福韦联合福辛普利具有更好的降低尿蛋白及控制患者血压的效果,对于远期治疗效果,还需要延长随访时间来明确。

关键词: 丙酚替诺福韦, 福辛普利, 乙型肝炎相关性IgA肾病

Abstract: Objective To compare the treatment effects of propofenofovir combined with fosinopril and entecavir combined with fosinopril on patients with hepatitis B-related IgA nephropathy.Methods Seventy-two patients with hepatitis B-related IgA nephropathy were enrolled in this study, They were divided into two groups based on which treatment regime of antiviral drugs they received. Thirty-five patients in group A were treated with propofol combined with fosinopril, while 37 patients in Group B was treated with entecavir combined with fosinopril. The therapeutic effects were compared at 12 and 24 weeks after treatments. Results In the initial comparison between the two groups, there was no significant difference in gender, average age, 24-hour urine protein quantity, serum albumin, proportion of urine occult blood, systolic blood pressure, diastolic blood pressure, urinary protein creatinine ratio, urea nitrogen, serum creatinine (SCR), LG HBV DNA quantitation. After 12 weeks of treatment, 24-hour urine protein (0.45±0.15 vs. 0.69±0.17, t=-6.208, P<0.01), serum albumin (t=2.799, P<0.01), and the proportion of patients with positive HBV DNA (20% vs. 43.2%, χ² = 4.470, P<0.01) in group B patients were significantly higher than those in group A (P<0.01). Similarly, there was no significant difference in systolic blood pressure, diastolic blood pressure, SCR, urinary occult blood (> 2 +) and urea nitrogen, Lee grade III and above in group A and group B patients at their baselineeline levels. After 24 weeks of treatment, 24-hour urinary protein quantitation (0.13±0.06, vs 0.23±0.08, t=-5.565, P<0.01), serum albumin (t=4.673, P<0.01), systolic blood (t=-5.704, P<0.01), systolic blood pressure (t=-5.704, P<0.01), diastolic blood pressure (t=-2.657, P=0.010), SCR (69.76±22.00, 84.08±18.76,t=-2.986, P<0.01), proportion of patients with positive LG HBV DNA quantitation (8.6% vs 27%, 27%, 27%, 27%, χ²=-4.141, P=0.042), proportion of patients with Lee grade III and above (8.6% vs 29.7%, χ²=3.878, P=0.049) were significant different between the two groups.Conclusion Compared with entecavir combined with fosinopril in the treatment of hepatitis B-related IgA nephropathy, propofenofovir combined with fosinopril has better consequence in reducing urine protein and controlling blood pressure of patients. It is necessary to further extend the follow-up time to confirm the long-term treatment effect.

Key words: Tenofovir alafenamide, Fosinopril, Hepatitis B related IgA nephropathy

赖华梅, 王俊, 王鸿. 丙酚替诺福韦联合福辛普利治疗乙型肝炎相关性IgA肾病疗效分析[J]. 肝脏, 2021, 26(2): 136-139.

LAI Hua-mei, WANG Jun, WANG Hong. Efficacy of propofenofovir combined with fosinopril in the treatment of hepatitis B-related IgA nephropathy[J]. Chinese Hepatolgy, 2021, 26(2): 136-139.

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