中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (11): 644-648.doi: 10.3969/j.issn.1671-4091.2015.11.002

• 临床研究 • 上一篇    下一篇

慢性乙型肝炎病毒感染者肾脏早期损伤指标变化及其影响因素

李海1.3,韩涛2,李岩2,陈林艳1,王毓麟1,向晓辉1.3, 杨绍广3,朱理珉1   

  1. 300162 天津，1武警后勤学院附属医院肝胆胰脾科
    200170 天津，2天津市第三中心医院消化科
    300380 天津，3天津市西青医院消化科
  • 收稿日期:2015-05-21 修回日期:2015-09-20 出版日期:2015-11-12 发布日期:2015-11-12
  • 通讯作者: 李海 15202265600@163.com E-mail:15202265600@163.com
  • 基金资助:

    天津市应用基础及前沿技术计划重点项目(12JCZDJC25500)；武警后勤学院创新团队基金项目(WHTD201310)；西青医院院级课题基金面上项目(XQLX201407)

The early renal injury and its related factors in patients with chronic HBV infection

  • Received:2015-05-21 Revised:2015-09-20 Online:2015-11-12 Published:2015-11-12

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摘要： 目的了解慢性乙型肝炎病毒感染患者部分肾功能早期损伤指标变化及其影响因素。方法  对2012 年4 月～2013 年6 月于武警后勤学院附属医院和天津市第三中心医院就诊的慢性乙型肝炎病毒感染患者90 名进行调查，患者分别诊断为慢性乙型肝炎、乙型肝炎肝硬化及乙型肝炎病毒相关肝癌。进行尿微量白蛋白、尿转铁蛋白、尿IgG、血清b2微球蛋白检测评价患者早期肾脏功能。并同时检测患者肝肾功能，测算患者eGFR 水平，并记录患者性别、年龄、血压、体质量及药物使用情况等一般信息。比较不同诊断乙型肝炎感染患者肾脏早期功能损伤的程度是否存在不同。随后按照是否存在肾功能早期损伤将患者诊断、一般情况等纳入多因素分析，找出慢性乙型肝炎病毒感染者肾功能早期损伤指标异常可能相关因素。结果所有检测慢性乙型肝炎病毒感染者的血清肌酐水平均在正常检测范围。所有患者的
eGFR 异常率为12.7%，但肾功能早期损伤指标异常率高达72.2%(c2=56.25，P=0.000)。患者疾病状态不同则肾功能早期损伤指标异常情况也不相同。尿转铁蛋白在慢性乙型肝炎、乙型肝炎肝硬化及肝癌患者数值分别为(1.91±1.06)mg/L、(2.66±3.01)mg/L、(6.73±8.32)mg/L，3 组间比较差异有统计学意义(F=7.669，P=0.001)；尿IgG 的异常率在3 组分别为4/30 (13.3%),15/29 (51.7%),11/30(36.7%),差异有统计学意义(F=10.39,P=0.006);血清b2 微球蛋白异常率分别为10/30(33.3% ),18/29(62% ),23/30(76.7%),差异有统计学意义(F=12.75,P=0.002)。经Logistic 回归分析，慢性乙型肝炎病毒感染者肾功能早期损伤指标异常的独立危险因素为患者年龄及疾病状态。结论我们的研究初步表明，慢性乙型肝炎病毒感染者中，肾功能早期损伤异常率明显高于eGFR异常率，患者年龄和疾病状态是导致肾功能早期损伤指标异常的独立危险因素。但这种异常的具体临床意义有待进一步观察研究。

关键词: 乙型肝炎病毒, 肾小球滤过率, 肾功能不全, 肝硬化

Abstract: 【Abstract】Background Clinically, hepatitis B virus (HBV) infection has been observed to be associated with nephropathy. Regular monitoring of renal function is recommended because comorbidities or antiviral treatment might further increase the renal injury. The well-established formulae using serum creatinine for the calculation of glomerular filtration rate (eGFR) are validated only for patients with substantially impaired renal function but not suitable for monitoring patients with normal renal function. There are few data of early renal injury evaluated in patients with chronic HBV infection. Methods A multicenter, retrospective and observational study was carried out in 2 hospitals in Tianjin, China between April 2012 and June 2013. The study recruited 90 patients with chronic HBV infection who never received antiviral treatment. Based on the hepatitis status, they were divided into three groups including chronic hepatitis group, liver cirrhosis group, and hepatic carcinoma group. Patients were assessed for early renal injury by urinary albumin, urinary transferrin,urinary IgG, and serum β2-microglobulin. Clinical information and other laboratory data including serum creatinine and eGFR were also collected for diagnosis. Patients’data from two laboratories were pooled together and analyzed among the three groups. Logistic regression analysis was conducted to determine the association between early renal injury and the variables including age, gender, comorbidities (diabetes and hypertension), and chronic disease stages. Results Serum creatinine level was in normal range in all patients. However, the abnormal rate of albumin, transferrin, IgG in urine, and serum β2-microglobulin were much higher than that of eGFR (72.2% vs. 12.7%, c2=56.25, P=0.000). The proportion of early renal injury was different in different status of chronic HBV infection. In patients with chronic hepatitis, cirrhosis and liver cancer, urinary transferrin levels were 1.91±1.06 mg/L, 2.66±3.01 mg/L, and 6.73±8.32 mg/L, (c2=7.671, P=0.001), respectively; abnormal urinary IgG level was found in 4/30 (13.3%), 15/29 (51.7%) and 11/30 (36.7%) (F=10.39, P=0.006), respectively of the patients; abnormal β2-microglobulin level was found in 10/30 (33.3%), 18/29 (62%) and 23/30 (76.7%) (F=12.75, P=0.00), respectively of the patients. Logistic regression analyses showed that aged patients and liver disease status were the independent risk factors for early abnormal renal function in patients with chronic HBV infection. Conclusions The prevalence of early renal injury with normal eGFR is higher in patients with HBV infection. Age and disease status are the main factors affecting the early renal injury. Assessment of early renal injury is required before antiviral treatment in these patients.

Key words: Hepatitis B Virus, Estimated Glomerular Filtration Rate, Liver Cirrhosis