Analysis Of Renal Function In 626 Patients With Chronic Hepatitis B

Objective: In order to provide guidance for the diagnosis and treatment of chronic hepatitis B,we analyzed and compared the renal function of the patients with chronic hepatitis B.Methods: This research was a retrospective study.We collected 626 patients with chronic hepatitis B as the study group in our hospital from January 2013 to July 2016.The patients were divided into 6 groups according to the diagnosis and prevention of hepatitis B,which were 145 cases of mild patients,171 cases of moderate cases patients and 84 cases of severe patients,87 cases of compensated cirrhosis,99 patients of decompensated cirrhosis,40 cases of liver failure.At the same time,100 patients with normal liver and kidney function were selected as control group.The clinical data were collected in each group,including age,gender,clinical features,liver and kidney function,urine analysis,HBV-DNA,and imaging features.Renal function indicators(Bun,Scr,GFR,Cys C,urine m ALB,urine BLD)were applied to evaluate the differences in predicting renal damage,as well as regression analysis the effect of gender,age,liver and kidney function,HBe Ag,and HBV-DNA on glomerular filtration rate(GFR).Results: The clinical symptoms of CHB patients mainly manifested as fatigue,norexia,liver discomfort,abdominal distension,yellow sclera,yellow urine,and other symptoms of hepatitis splenomegaly.With the aggravation of the disease,the symptoms were gradually obvious,and the constituent ratio of different hepatitis symptoms in each group was significantly different(P<0.05).However,the symptoms of kidney damage in each group(such as lumbar pain,eyelid edema,hematuria,proteinuria,hypertension,etc.)are not obvious,and there was no significant difference between the groups(P>0.05).The study group were mainly liver damage,liver function indexes(ALB,TBIL,ALT,AST,γ-GT)was significantly higher than the control group(P<0.05).With the severity of the disease in the study group,the ALB decreased,the TBIL,ALT,AST,and γ-GT increased.The ALB,TBIL,ALT.AST and γ-GT means were not all equal between groups(P < 0.05).In the study group,the mean values of Bun,Cr and GFR were higher than the control group,the difference was statistically significant(P<0.05).The Cys C of study group was(1.73 ± 10.40)mg/L,the Cys C of control group was(0.96±0.14)mg/L,there was no significant difference of mg/L(t=1.85,P>0.05).However,the positive rate of Cys C above the normal reference value gradually increased with the progress of the disease,the difference was statistically significant(P<0.05).In the study group,the renal damage of decompensated liver cirrhosis and liver failure was more obvious by comparing and analyzing each group and control group,which Bun,Scr and Cys C indicators were significantly increased,the GFR decreased significantly,there were no significant difference between Cys C(F=1.31,P>0.05).GFR level of study group were negatively correlated with age,TBIL,Bun,Scr and Cys C(r=-0.31;r=-0.21;r=-0.53;r=-0.61;r=-0.12;P<0.01),and GFR was positively correlated with ALB(r=-0.11,P<0.01),but the correlation coefficient was less than0.5,so the correlation between age,ALB,TBIL,Cys C and GFR was weaker,Bun,Scr and GFR were strongly correlated.The study group overall Cys C were positively correlated with Bun and Scr(r=0.169,P < 0.01;r=0.128,P < 0.01),Cys C was negatively correlated with ALB(r=-0.079,P<0.05).and Cys C had no correlation with age,TBIL,ALT,AST and γ-GT(r=-0.004,P=0.928;r=0.008,P=0.835;r=-0.029,P=0.458;r=-0.019,P= 0.62;r=-0.025,P=0.532).But the correlation coefficient is less than 0.5,so the correlation was weak.In this study,the overall abnormal renal function [e GFR<90 m L/(min 1.73 m 2)]the incidence rate was 13.10%,including mild group was 4.83%,moderate group was3.51%,severe group was 9.52%,the compensatory group was 13.79%,decompensated liver cirrhosis group was 29.90%,liver failure group was 50%,the difference were statistically significant(χ2= 94.17,P<0.05).The abnormal rate of renal function in decompensated liver cirrhosisand liver failure group was significantly higher than that in other groups,there was no significant difference between mild and moderate group(χ2=0.35,P>0.05).Further analysis of the overall,different indicators have differences on the evaluation of renal function.The positive rates of Bun,Scr,Cys C,urine ALB,m ALB and urine BLD above the normal limit were 13.26%,4.95%,36.10%,14.22%,23.96% and 11.34%.The difference of seven indexes in evaluating renal function was statistically significant(χ2=282.03,P<0.01).The ratio of Cys C and urine m ALB was significantly higher than other indicators,the positive rate of Cys C was higher than m ALB(χ2=21.96,P<0.01).In this study,the results of univariate Logistic regression analysis showed that older age,male,HBe Ag positive,ALB,and UA,may be the risk factors of GFR decline.Further multivariate regression analysis showed that age,male,UA levels were independent risk factors for GFR decline.Conclusion: The clinical symptoms of the patients with CHB mainly manifested as fatigue,anorexia,liver discomfort,abdominal distension,yellow sclera,yellow urine,which were associated with renal function damage.However,the early symptoms are not obvious,but also ignored,And older age,male,HBe Ag+,ALB decreased,UA elevated risk factors for GFR.We should actively strengthen the monitoring of Cys C and urine m ALB in order to early detection and control of renal damage.