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目的应用来氟米特、甲泼尼龙联合恩替卡韦治疗乙肝病毒相关性肾炎(HBV-GN),对比单独应用恩替卡韦抗病毒治疗,探讨来氟米特、甲泼尼龙联合恩替卡韦治疗乙肝病毒相关性肾炎(HBV-GN)的效果及安全性。方法选择2014年1月—2015年12月间37例住院HBV-GN患者,均经肾穿刺活检确诊,其中21例治疗组应用来氟米特、甲泼尼龙联合恩替卡韦治疗,16例对照组仅恩替卡韦抗病毒治疗。治疗3个月、6个月后比较2组患者尿蛋白减少情况、谷丙转氨酶(ALT)指标以及HBV-DNA复制水平。结果治疗3个月后,治疗组患者尿蛋白(1.76±1.20)g/24 h,显著优于对照组(2.70±1.50)g/24 h,(P<0.05),治疗6个月后,治疗组患者尿蛋白(1.61±0.90)g/24 h,显著优于对照组(2.34±1.20)g/24 h,差异有统计学意义(P<0.05),ALT(17.0±6.3)U/L与对照组(19.7±4.0)U/L相比差异无统计学意义(P>0.05),3个月抗病毒治疗后监测2组患者HBV-DNA水平均在正常范围;ALT(19.0±4.7)U/L与对照组(18.3±4.4)U/L相比差异无统计学意义(P>0.05),2组HBVDNA水平均在正常范围。结论乙肝病毒相关性肾炎的治疗目前临床上并无统一意见,患者常因尿蛋白难以得到控制而在数年内进展至终末期肾病,患者生活质量的明显下降甚至危及生命,而且对国家医疗保险造成了沉重负担。来氟米特、甲泼尼龙联合恩替卡韦在HBV-GN治疗中的效果以及安全性目前仍不明确,通过本次研究,希望为HBV-GN诊治思路提供依据。
Objective To compare levofloxacin, methylprednisolone and entecavir in the treatment of hepatitis B virus-related nephritis (HBV-GN). To compare the effects of levofloxacin, methylprednisolone and entecavir alone in the treatment of hepatitis B virus-related nephritis HBV-GN) effect and safety. Methods 37 hospitalized HBV-GN patients from January 2014 to December 2015 were selected and confirmed by renal biopsy. Among them, 21 patients in the treatment group received leflunomide, methylprednisolone and entecavir, and 16 in the control group only Antiviral treatment of entecavir. After 3 and 6 months of treatment, the urinary protein, ALT and HBV-DNA replication were compared between the two groups. Results After 3 months of treatment, urinary protein (1.76 ± 1.20) g / 24 h in the treatment group was significantly higher than that in the control group (2.70 ± 1.50) g / 24 h (P <0.05). After 6 months of treatment, The urinary protein in group (1.61 ± 0.90) g / 24 h was significantly higher than that in control group (2.34 ± 1.20) g / 24 h, the difference was statistically significant (P <0.05) There was no significant difference in U / L between control group (19.7 ± 4.0) and control group (P> 0.05). The levels of HBV-DNA in the two groups after 3 months of antiviral therapy were within the normal range. ALT (19.0 ± 4.7) U / L and control group (18.3 ± 4.4) U / L, the difference was not statistically significant (P> 0.05), two groups of HBVDNA levels were in the normal range. Conclusion The treatment of hepatitis B virus-associated nephritis is currently no clinical opinion. Patients often have difficulty in controlling urinary protein and progress to end-stage renal disease within a few years. The quality of life of patients is significantly reduced or even life-threatening, A heavy burden. The efficacy and safety of leflunomide, methylprednisolone and entecavir in the treatment of HBV-GN are still not clear. Through this study, we hope to provide evidence for the treatment of HBV-GN.