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目的评价核苷(酸)类似物治疗乙型肝炎(乙肝)病毒相关性肾炎(hepatitis B virus-associated glomerulonephritis,HBV-GN)合并慢性乙肝或肝硬化的临床疗效和安全性。方法选择病理诊断为HBV-GN,同时合并慢性乙肝或肝硬化的患者共36例。患者分成2组:核苷(酸)类似物抗病毒治疗组25例,给予拉米夫定0.1g,1次/d,或恩替卡韦0.5mg,1次/d,空腹口服;对照组11例,未给予核苷(酸)类似物抗病毒治疗。2组均给予常规保肝降酶及保护肾功能的治疗。观察治疗前后临床指标变化,包括用药期间尿蛋白排泄情况、肝肾功能和乙肝病毒学指标以及不良反应。结果治疗12个月时,抗病毒治疗组24h尿蛋白定量较治疗前明显减少,血清ALB较治疗前明显升高;对照组24h尿蛋白定量和ALB与治疗前相比无显著改善。2组ALT和AST水平治疗后均明显改善,但抗病毒治疗组ALT和AST下降幅度明显大于对照组。抗病毒治疗组血清HBV DNA水平治疗后明显下降,对照组治疗前后无明显变化。抗病毒治疗组治疗12个月时的完全缓解率、总有效率明显高于对照组。结论核苷(酸)类似物治疗HBV-GN,可显著降低尿蛋白,使ALB升高,HBV DNA水平降低,缓解肾病综合征的临床症状,取得满意疗效,且耐受性好,未见明显不良反应。
Objective To evaluate the clinical efficacy and safety of nucleoside (acid) analogues in the treatment of hepatitis B virus-associated glomerulonephritis (HBV-GN) combined with chronic hepatitis B or cirrhosis. Methods The pathological diagnosis of HBV-GN, combined with chronic hepatitis B or cirrhosis in patients with a total of 36 cases. The patients were divided into 2 groups: 25 cases of nucleoside (acid) analog anti-virus treatment group, given lamivudine 0.1g, 1 times / d, or entecavir 0.5mg, 1 times / d, fasting oral; control group of 11 cases, No nucleoside (acid) analog anti-viral treatment was given. Both groups were given routine liver protection and renal function of renal protection treatment. Changes of clinical indexes before and after treatment were observed, including urinary protein excretion, hepatic and renal function, hepatitis B virus and adverse reactions. Results At 12 months, the 24 h proteinuria in antiviral therapy group was significantly lower than that before treatment, serum ALB was significantly higher than that before treatment; 24 h urinary protein and ALB in control group were not significantly improved compared with those before treatment. The levels of ALT and AST in both groups were significantly improved after treatment, but the decrease of ALT and AST in the antiviral treatment group was significantly greater than that in the control group. The levels of serum HBV DNA in the antiviral treatment group decreased significantly after treatment, but there was no significant change in the control group before and after treatment. The complete remission rate of the antiviral therapy group at 12 months was significantly higher than that of the control group. CONCLUSION: Nucleotide analogue treatment of HBV-GN can significantly reduce urinary protein, increase ALB and reduce HBV DNA level, relieve the clinical symptoms of nephrotic syndrome and achieve satisfactory curative effect with good tolerance and no obvious Adverse reactions.