| Purpose:To compare renal function changes in chronic hepatitis B(CHB) patients before and after antiviral medicine treatment between telbivudine and entecavir, assess the impact on renal function in these patients with mild renal impairment,and provide the evidence for optimizing antiviral treatment.Method:120 chronic hepatitis B patients were enrolled for the study,telbivudine(600 mg/d)and entecavir(0.5 mg/d)treatment were carried out in different groups. The normalization rate of alanine aminotransferase(ALT),undetectable rate of HBV DNA,serum creatinine(CR)and estimated glomerular filtration rate(e GFR)were compared on baseline period,52 weeks,and 104 weeks,respectively.Result:At week 104 from baseline,renal function in telbivudine group was significantly improvement.Both of creatinine and e GFR were significantly improved in the telbivudine group(t=2.917、p=0.005 and t=-2.736、p=0.008). But no significant difference was found in the entecavir group. At week 104, There was significant difference between in terms of creatinine and e GFR between the telbivudine group and the entecavir group(t=-2.727、p=0.007 and t=2.218、p=0.028).Subgroup analysis of e GFR mean change showed that both telbivudine-treated and entecavir-treated patients with worse baseline e GFR(<90 m L·min-1·1.73 m-2) had better e GFR improvement(25.93±2.21,n=11 vs 8.17±10.14,n=7),and there was significantly difference between the telbivudine group than the entecavir group(t=4.323、p=0.001).Virological breakthrough was even more in the telbivudine group than the entecavir group at week 104(15% vs 1.7%,p=0.017).Conclusion:To be Compared with entecavir, telbivudine treatment showed a renoprotective effect in patients with CHB. For the HBV patients with high risks for renal impairment, telbivudine should be more renoprotective effect. But this did not support the use of telbivudine as a first-line NUC of the na?ve HBV patients, because of its high rate of virological resistance. |
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