| Objective Objective to analyze the influence factors of glomerular filtration rate in patients with chronic hepatitis B treated with adefovir dipivoxil for a long time,so as to provide reference for clinical treatment..Method Using the retrospective analysis method,134 patients with chronic hepatitis B were collected using adefovir dipivoxil in the period from January 2011 to January 2016 infection in the First Affiliated Hospital of Zhengzhou University.The initial use of datas were collected: age,gender,alanine aminotransferase(ALT)and aspartate aminotransferase(AST),r-glutamyltranspeptidase(GGT),alkaline phosphatase(ALP),HBV DNA,glomerular filtration rate(e GFR).Renal function and other laboratory parameters were examined every 3-6 months.The calculation formula of glomerular filtration rate in this study:CKD-EPI.According to the glomerular filtration rate compared with the baseline values,the patients were divided into two groups: group A(glomerular filtration rate decreased less than or equal to 20% compared with baseline values),B group(glomerular filtration rate decreased greater than or equal to 20% compared with baseline values).Through thecomparison of two groups of cases,the application of logistic single factor and multi factor regression analysis of influencing factors of glomerular filtration rate decreased more than 20% compared with baseline of the patients.Result 1(1)The glomerular filtration rate of 37 cases decreased more than 20% compared with baseline,accounting for 27.61% of cases.(2)Data were compared before treatment: A group including 53 males of 97 cases,21 males of 37 cases in B group,two groups had no statistically significant difference(P>0.05);group A(36.25+11.49)for the age of initial treatment,B treatment group began to age(57.11+9.40),the difference was statistically the significance(P < 0.05);,The glomerular filtration rate(110.10+5.81)ml/min in group A had significant difference withthe glomerular filtration rate(100.51+5.29)ml/min of B group(P < 0.05);The treatment course had significant difference between A group(2.48+0.48)and B group(3.52+0.60)(P < 0.05);ALT,AST,GGT,ALP,HBV DNA in two groups showed no significant difference(P > 0.05).2.The gender,age,ALT,AST,GGT,ALP,HBV,DNA,e GFR and the treatment course in the B group were analyzed by single factor Logistic regression,the results showed that age,e GFR and treatment course are the factors influencing glomerular filtration rate.According to the results of single factor analysis further multivariate logistic regression analysis: age(OR=1.14,P=0.01),treatment course(OR=81.34,P=0.00),e GFR(OR=0.85,P=0.00)were associated with e GFR decreased more than 20% compared with that before treatment.3.Especially for patients over 50 years of age,treatment course more than 3 years,and low e GFR before treatment,which were the risk factors for the influence of adefovir dipivoxil on glomerular filtration rate in chronic hepatitis B.4.In this study,3 patients were diagnosed as Fanconi syndrome,including 1 cases of normal blood phosphorus,2 cases of persistent hypophosphatemia,and one case in low phosphorus osteomalacia,timely stopping adefovir,adjust the antiviral program,clinical symptoms and indicators have improved markedly.Conclusion 1.Age,treatment course,and e GFR before treatment were the factors for the influence of adefovir dipivoxil on glomerular filtration rate in patients with chronic hepatitis B.2.Adefovir dipivoxil treatment of chronic hepatitis B colud occur hypophosmia,Fanconi syndrome and hypophosphatyurism,through the timely suspension of adefovir dipivoxil,adjust the antiviral program,the above situation can be Obviously improved. |
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