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摘要：
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摘要：目的 探讨替比夫定治疗乙型肝炎病毒相关性肾炎（hepatitis B virus associated glomerulonephritis，
HBV-GN）患者的临床疗效。方法 选取2010年5月至2015年12月于佛山市第五人民医院治疗的HBV-GN
患者66例为研究对象，随机分为治疗组和对照组，每组33例。两组患者均给予相应的常规治疗，对照
组加用拉米夫定片100 mg，每日1次；治疗组加用替比夫定片600 mg，每日1次。检测HBV DNA载量、
ALT、血肌酐（serum creatinine，SCr）、肌酸激酶（creatine kinase，sCK）、尿蛋白肌酐比值（ACR：
UP/Cr）、尿β2微球蛋白（β2 microglobulin，β2-MG）和24小时尿蛋白定量。结果 治疗组和对照组患
者的临床有效率分别为90.90%、78.78%，差异有统计学意义（χ 2 = 5.647，P = 0.014）。治疗48周后，
治疗组患者HBV DNA阴转率（97.5%）显著高于对照组（89.5%），差异有统计学意义（χ 2 = 4.912，
P = 0.025）。治疗组患者48周时SCr、ACR：UP/Cr、24小时尿蛋白、尿β2-MG水平与基线相比差异
有统计学意义（t值分别为8.972、7.209、2.164、6.754，P值分别为0.013、0.034、0.041、0.038）。
治疗组患者在治疗期间肾小球滤过率（glomerular filtration rate，eGFR）逐渐升高，第24周和48周时
与基线比较差异有统计学意义（t = 2.235，P = 0.028；t = 2.544，P = 0.013）；而对照组患者eGFR呈
下降趋势，第48周与基线比较差异有统计学意义（t = 2.21，P = 0.031）。治疗组患者48周肌酸激酶
（creatine kinase，CK）升高率（12.1%）显著高于对照组（3.0%），差异有统计学意义（χ 2 = 5.838，
P = 0.014）。结论 替比夫定治疗HBV-GN的临床疗效较好，还具有改善肾功能的作用，治疗过程中需
关注患者CK水平的变化。
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Abstract: Objective To investigate the clinical effects of telbivudine in the treatment of hepatitis B virus
associated glomerulonephritis (HBV-GN). Methods Total of 66 cases with HBV-GN in the Fifth People’s
Hospital of Foshan from May 2010 to December 2015 were selected and randomly divided into treatment
group and control group, 33 cases in each group. Patients in both groups were given the appropriate
conventional treatment. Patients in control group were given additional lamivudine tablets (100 mg, one time
per day) and patients in treatment group were given additional telbivudine tablets (600 mg, one time per day).
HBV DNA load, levels of alanine aminotransferase (ALT), serum creatinine (SCr), creatine kinase (CK),
urinary protein-creatinine ratio (ACR: UP/Cr), urinary β2-microglobulin (β2-MG) and 24-hour urinary protein
quantification were detected. Results The clinical effective rates of patients in treatment group and control
group were 90.90% and 78.78%, respectively, the difference was statistically significant (χ 2 = 5.647, P = 0.014).
After 48 weeks treatment, the negative conversion rate of HBV DNA in treatment group was 97.5% and was
significantly higher than that in the control group (89.5%; χ 2 = 4.912, P = 0.025). Compared with baseline,
there were significant differences in levels of SCr, ACR: UP/Cr, 24 h urine and urinary β2-MG of patients in
treatment group after 48 weeks treatment (t = 8.972, 7.209, 2.164, 6.754; P = 0.013, 0.034, 0.041, 0.038). The
glomerular filtration rate (eGFR) of patients in treatment group increased gradually during treatment, which
were significantly different among the 24th week, 48th week and baseline (t = 2.235, P = 0.028; t = 2.544, P =
0.013). However, eGFR of patients in control group tended to decrease and was significantly different between
the 48th week and baseline (t = 2.21, P = 0.031). After 48 weeks of treatment, the rising rate of CK in treatment
group was 12.0%, which was significantly higher than that in the control group (3.0%; χ 2 = 5.838, P = 0.014).
Conclusion Telbivudine has not only a good clinical efficacy on HBV-GN, but also can improve renal function.
However, more attention should be paid to the changes of CK in patients treated with telbivudine.
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