核苷(酸)类药物联合激素治疗慢性HBV感染合并肾病综合征的疗效观察

方佩佩 金玲湘 林巍 周光耀

[摘要] 目的 探讨核苷（酸）类抗病毒药物联合激素治疗慢性HBV感染合并肾病综合征（NS）的临床疗效。 方法 18例慢性HBV感染合并NS患者随机分为三组：慢性活动性乙肝组（A组）、慢性HBV携带者组（B组）和非活动性HBV携带者组（C组），均予激素治疗，前两组联用抗病毒药物，而C组未联用，观察24 h尿蛋白定量、肝功能及HBV DNA水平。 结果 所有患者尿蛋白均有所下降，前两组的HBV DNA载量有所下降，而C组则有部分出现HBV的再激活并伴不同程度的肝损。 结论 慢性HBV感染合并NS在接受激素治疗时，应及时予以规范的抗病毒治疗，可有效避免激素引起的乙肝病毒再激活。

[关键词] 核苷（酸）类药物；激素；乙肝；原发性肾病综合征

[中图分类号] R692.3；R512.62[文献标识码] B[文章编号] 1673-9701（2012）16-0071-02

Clinical efficacy of nucleoside (acid) drugs combined with glucocorticoid in treatment of chronic HBV infection complicated with nephrotic syndrome

FANG Peipei JIN Lingxiang LIN Wei ZHOU Guangyao

Department of Infectious Diseases, the Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China

[Abstract] Objective To explore the clinical efficacy of nucleoside (acid) drugs combined with glucocorticoid in treatment of chronic hepatitis B virus infection complicated with nephrotic syndrome. Methods Eighteen patients with HBV infection complicated with nephrotic syndrome were treated by glucocorticoid, parts of them were also treated by nucleoside (acid) drugs. The 24-hour urinary protein, liver function and HBV DNA level were observed. Results After the treatment of glucocorticoid, all the urinary protein were decreased. The HBV DNA levels of the groups together with the treatment of nucleoside (acid) drugs were reduced while the HBV DNA of the third group was broken through and with varying degrees of liver damage. Conclusion Antiviral therapy should be adopted when chronic HBV infection complicated with nephrotic syndrome receiving hormone therapy, which can effectively avoid the HBV reactivation caused by hormone.

[Key words] Nucleoside (acid) drugs; Glucocorticoid; Hepatitis B; Primary nephrotic syndrome

慢性HBV感染合并肾脏疾病患者主要包括两种情况：①HBV相关肾损害，主要为HBV相关肾小球肾炎（hepatitis B virus associated glomerulonephritis，HBV-AG）；②合并其他肾病，包括肾病综合征（nephrotic syndrome，NS）、慢性肾小球肾炎等。其中肾病综合征患者常需应用糖皮质激素治疗，目的在于消除或减少尿蛋白，防止或延缓肾功能恶化。患者如同时合并乙肝病毒感染则因为病毒复制的问题而使治疗变得相当棘手。本研究旨在观察核苷（酸）类抗病毒药物联合激素治疗慢性HBV感染合并原发性肾病综合征患者的临床疗效。

1 资料与方法

1.1 一般资料

回顾性分析2008年8月～2011年6月在温州医学院附属第二医院肾内科及感染内科住院治疗的慢性HBV感染合并原发性肾病综合征的患者共18例，其中男11例，女7例，年龄16～60岁，平均38.5岁。所有病例临床均符合肾病综合征的诊断标准：24 h尿蛋白定量≥3.5 g，血浆白蛋白≤30 g/L，血脂升高，伴或不伴浮肿，均有糖皮质激素的临床应用指征。……