Influence of long-term entecavir treatment on renal function in patients with chronic hepatitis B

• Main Author: ZHANG Qing
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2020-07-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=10872

ObjectiveTo investigate the influence of long-term entecavir (ETV) antiviral therapy on renal function in patients with chronic hepatitis B (CHB). MethodsA retrospective analysis was performed for the clinical data of 232 CHB patients who received ETV antiviral therapy for more than half a year in Huai’an Fourth People’s Hospital from January 2015 to June 2019. The patients were divided into groups according to sex, age (＜65 years or ≥65 years), presence or absence of liver cirrhosis, and estimated glomerular filtration rate (eGFR) (＜90 ml/min/1.73 m2 or ≥90 ml/min/1.73 m2), and the changes in renal function markers ［blood urea nitrogen (BUN), serum creatinine (SCr), and eGFR］ after treatment were observed for each group. The changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (Alb), HBsAg, HBV DNA, and renal function markers (BUN, SCr, and eGFR) after ETV antiviral therapy were also observed. An automatic biochemical analyzer was used to measure biochemical parameters including ALT, AST, Alb, BUN, SCr, and eGFR; RT-qPCR was used to measure HBV DNA; Roche electrochemical luminescence was used to measure serum HBsAg quantification. The paired t-test was used for comparison of normally distributed continuous data between groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups; a binary logistic regression analysis was used to identify the risk factors for eGFR ＜90 ml/min/1.73 m2 after ETV antiviral therapy. ResultsAfter ETV antiviral therapy for more than half a year, there were significant reductions in ALT, AST, HBsAg, and HBV DNA (Z=-9.496 and -9.577, t=5.013 and 20.777, all P＜0.05) and a significant increase in Alb (t=-10.832, P＜0.05); compared with baseline, there were significant increases in BUN and SCr (t=-2.685 and -2.376, both P＜0.05) and a significant reduction in eGFR (t=3.207, P＜0.05). Further analysis of each subgroup showed that the eGFR ≥90 ml/min/1.73 m2 group, the non-elderly group, the liver cirrhosis group, and the male group had significant increases in BUN (t=-3.403, -3.187, -2.267, and -2.187, all P＜0.05) and SCr (t=-3.716, -3.614, -2.291, and -2.115, all P＜0.05) and a significant reduction in eGFR (t=4.846, 4.152, 2.458, and 2.946, all P＜0.05), and the non-liver cirrhosis group had a significant reduction in eGFR (t=2.163, P＜0.05) and had no significant changes in BUN and SCr (P＞0.05). The binary logistic regression analysis showed that with the increase in glucose level (odds ratio ［OR］=1.296, 95% confidence interval ［Cl］: 1.052-1.597, P=0.015) and the reduction in total cholesterol (TC) (OR=0.436, 95% Cl: 0.286-0.664, P＜0001), the risk of eGFR ＜90 ml/min/1.73 m2 increased after ETV therapy. ConclusionETV antiviral therapy can effectively reduce ALT, AST, HBsAg, and HBV DNA and increase Alb, but it can cause the increases in BUN and SCr and the reduction in eGFR in patients with eGFR ＞90 ml/min/1.73 m2, non-elderly patients, and patients with liver cirrhosis. Blood glucose and TC are influencing factors for eGFR ＜90 ml/min/1.73 m2 after ETV therapy.