Application of leflunomide and methylprednisolone combined with entecavir in the treatment of hepatitis B virus associated glomerulonephritis
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摘要: 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HBV-DNA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。Abstract: Objective To explore the efficacy and safety of leflunomide and methylprednisolone combined with entecavir for the treatment of HBV-associated glomerulonephritis(HBV-GN). Methods Thrity-seven patients hospitalized with HBV-GN from January,2014 to December,2015 were selected;all of them were confirmed with HBV-GN based on renal biopsy;Twenty-one patients were assigned to the treatment group to receive treatment with leflunomide and methylprednisolone combined with entecavir,and 16 patients were assigned to the control group to receive entecavir antiviral treatment alone.Patients in the two groups were compared for reduction in urine protein,ALT and HBV-DNA load at 3 and 6 months of treatment. Results After 3 months of treatment,the urine protein level in the treatment group was (1.76±1.20) g/24 h,which was significantly better than (2.70±1.50) g/24 h in the control group(P<0.05);at 6 months of treatment,the urine protein level in the treatment group was(1.61±0.90) g/24 h,which was significantly better than(2.34±1.20) g/24 h in the control group(P<0.05);there was no significant difference between the two groups in ALT(17.0±6.3) U/L in treatment group compare with (19.7±4.0) U/L in control group(P>0.05);by 3 months of antiviral treatment,HBV-DNA load had normalized in patients in both groups upon monitoring;there was no significant difference between the two groups in ALT(19.0±4.7) U/L in treatment group against (18.3±4.4) U/L in control group(P>0.05);and HBV-DNA load had normalized in both groups. Conclusion As the therapeutic approach for HBV-GN remains controversial in clinical practice,the patient would typically develop into ESRD within several years due to uncontrolled urine protein,which could markedly decline the patient's quality of life or even be life-threatening,and has been a heavy burden on the national medical insurance system.Considering that the efficacy and safety of leflunomide and methylprednisolone combined with entecavir for the treatment of HBV-GN remain unclear,this study is expected to provide more evidences for the management of HBV-GN.
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