阿德福韦酯联合拉米夫定治疗慢性乙肝和肝硬化致肾损害的特点及处理探讨

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Abstract Objective To observe the clinical characteristics of Adfovir Dipivoxil (ADV) combined with Lamivudine (LAM) in the treatment of chronic hepatitis B (CHB) and liver cirrhosis (LC) patients with renal hypophosphatemia and other adverse reactions, and to explore the efficacy of Entecavir (ETV) treatment. Methods From January 2012 to March 2018, patients with CHB and LC (Child-Pugh A grade) who were treated with LAM and ADV combined therapy (add-on scheme) after drug resistance in Zibo Central Hospital of Shandong Province were selected for routine examination. If adverse renal reactions such as hypophosphatemia were found, ADV and LAM were discontinued in time. Patients with mild or moderate CHB were selected as group A and replaced with ETV 0.5. Mg/d. Patients with severe CH B and LC were treated with ETV 1.0 mg/d as group B. Wilcoxon sign rank sum test of paired data was used for statistical analysis. Results Renal damage such as hypophosphatemia occurred after 63 (49, 71) months of add-on regimen treatment, and the biochemical indexes and symptoms gradually improved after ETV treatment. There were significant differences in blood scales and eGFR between the two groups after 6 months of drug change (P < 0.05). There was no significant difference in blood phosphorus and eGFR between the two groups before and after drug change (P > 0.05). Blood HBV DNA was still below the detection limit in all patients after dressing change. Conclusion Patients with CHB and HBV-related liver cirrhosis may develop hypophosphatemia and other adverse reactions after a long-term add-on therapy. Switching to ETV can reduce adverse effects and maintain the efficacy in inhibiting HBV replication.

Key words： Adefovir Entecavir Hypophosphatemia Hepatitis Type B Chronic

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	LI Xinwen1 FAN Yuchen2 XING Yanqing1 LU Yujuan1 HAN Liyan2 ZHANG Xiuhua1

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LI Xinwen1 FAN Yuchen2 XING Yanqing1 LU Yujuan1 HAN Liyan2 ZHANG Xiuhua1. Characteristics and treatment of Adefovir Dipivoxil combined with Lamivudine in the treatment of renal damage caused by chronic hepatitis B and cirrhosis[J]. 中国医药导报, 2019, 16(20): 164-167.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2019/V16/I20/164

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