Objective:Kidney damage in chronic hepatitis B(CHB)patients treated with oral nucleos(t)ide analogues(NAs)has attracted widespread attention.In recent years,the focus has been mainly on the estimated creatinine clearance rate(eGFR)calculated based on serum creatinine,but blood creatinine levels have many influencing factors and the kidney has a strong reserve function,so its sensitivity and reliability to reflect renal function are limited,and it cannot reflect early kidney damage.And eGFR mainly reflects glomerular filtration function,and numerous studies suggest that NAs mainly cause renal tubular damage.Therefore,the purpose of this study is to analyze the early renal damage(including glomerular and tubules)and its influencing factors in CHB patients with NAs,in order to provide a reference for the selection of antiviral therapy for chronic hepatitis B patients.Methods:A cross-sectional study was conducted on the kidney damage of outpatients who were older than 18 years old and treated with NAs for more than 1 year in the Affiliated Hospital of North Sichuan Medical College from October 2019 to October 2020.Collect clinical data of patients in the outpatient electronic medical record system,mainly including:gender,age,cirrhosis,liver function,five items of hepatitis B,Hepatitis B viral load,antiviral treatment plan and time,renal function and early kidney disease damage Indicators etc.SPSS23.0 software was used for analysis.Results:(1)Basic information:a total of 578 patients who met the inclusion criteria of this study were collected.After excluding cases with incomplete data,a total of 309 cases were included,including 92(29.8%)females and 217(70.2%)males;the youngest was 21 years old and the oldest was 76 years old,with the median age of 45 years old.65(21.0%)people had liver cirrhosis,and 9(2.9%)people had chronic kidney disease(CKD).Choice of antiviral drugs:113 patients used entecavir(ETV),accounting for 36.6%;73 patients used tenofovir disoproxil fumarate(TDF),accounting for 23.6%;68 people used adefovir dipivoxil(ADV),accounting for 22.0%;6 people used lamivudine(LAM);2 people used telbivudine(LdT);47(15.2%)people used two antivirals drugs:26 people(8.4%)used ADV+LAM,16 people(5.2%)used ETV+ADV,5 people(1.6%)used ETV+TDF.(2)Renal function test results:237 persons(76.7%)with eGFR>90 ml·min-1·1.73-2,65 persons(21.0%)with eGFR between 60~90 ml·min-1·1.73-2,and 7 people(2.3%)with eGFR less than 60 ml·min-1·1.73-2.Through univariate and multivariate analysis,it was found that age(OR=1.068)and liver cirrhosis(OR=1.971)were independent risk factors for the occurrence of decreased filtration rate(P<0.05);among the patients who only used ETV antiviral,the patients with decreased glomerular filtration rate accounted for 15.7%,and the patients in the nucleotide analog group(ADV or TDF)with decreased glomerular filtration rate accounted for 29.8%,and the difference was statistically significant(P<0.05).(3)Early kidney damage index test results:①Markers of glomerular damage:the number of people with elevated urine microalbumin,urine transferrin,and urine immunoglobulin G were 83(26.9%),45(14.6%)and 24 people(7.8%)respectively.If any one or more of the above three indicators were elevated,it was regarded as abnormal glomerular injury indicators.There were 90 people with abnormal glomerular injury indicators,accounting for 29.1%.Liver cirrhosis(OR=4.085)was an independent risk factor for abnormal glomerular injury indicators(P<0.05).②Marker of renal tubular injury:there were 173 people whose urine αl microglobulin increased,accounting for 56.0%.Age(OR=1.027),gender(OR=3.876),and antiviral time(OR=1.117)were independent risk factors for the increase of α1 microglobulin(P<0.05).③Markers of glomerular injury and markers of renal tubular injury are abnormal at the same time:if the glomerular injury index(at least one)and urine α1 microglobulin were abnormal at the same time,it was considered that the glomerular injury index and the renal tubular injury index were abnormal at the same time,which was 71(23.0%);④Early kidney disease damage indicators(urinary microprotein):an increase in either of the glomerular injury markers and the renal tubular injury markers was considered abnormal,and the number was 188(60.8%).⑤The results of glomerular and tubular markers in patients with ETV or nucleotide analogues:among patients who only used ETV antiviral,36.0%had abnormal glomerular injury indicators,and among patients who used nucleotide analogs(TDF and ADV)patients,25.8%had abnormal glomerular injury indicators,the difference between the two was not statistically significant(P>0.05);in patients only using ETV antiviral,50.6%of patients had renal tubular indicators were elevated.Among patients who only used nucleotide analogues antiviral,61.3%had elevated renal tubular indicators,and the difference between the two was not statistically significant(P>0.05).(4)Early kidney injury indicators in patients with different eGFR levels:in the three groups of patients with eGFR>90 ml·min-1·1.73-2,60 ml·min-1·1.73-2≤eGFR<90 ml·min-1·1.73-2 and eGFR<60 ml·min-1·1.73-2:the proportion of glomerular markers and tubular markers abnormalities gradually increased;the rates of simultaneous abnormality of glomerular and tubular markers also elevated.Conclusion:(1)Patients with chronic hepatitis B treated with nucleos(t)ide analogues may have kidney damage and need to be closely monitored,especially for the elderly,men,people with liver cirrhosis and long-term antiviral.(2)For patients with chronic hepatitis B treated with nucleos(t)ide analogues,in addition to close monitoring of their renal function,it is also necessary to pay attention to the indicators of early renal damage,especially the indicators of renal tubular damage.(3)In addition to nucleotide analogs(TDF and ADV)that have kidney damage,ETV may also have kidney damage,which also requires attention. |