一例乙肝相關性腎炎伴腎功能衰竭患者的循證治療_《中國循證醫學雜志》

作者：

鄒川 , 蘇國彬 , 盧富華 , 毛煒 ,  劉旭生

廣東省中醫院腎內科（廣州 510120）;

關鍵詞：

乙肝相關性腎炎腎功能衰竭循證實踐

DOI：

10.7507/1672-2531.20120058

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　針對近期收治的1例乙肝相關性腎炎伴腎功能衰竭患者，我們進行了證據檢索和評價，以期找到更有效的治療方法。
方法　計算機檢索Up to Date（2011.5）、Cochrane圖書館（Issue 5，2011）、PubMed（1978～2011）、CNKI（1978～2011），查找糖皮質激素或免疫抑制劑、抗病毒療法治療乙肝相關性腎炎及與病情緩解有關的系統評價、臨床隨機對照試驗等，并對所獲證據進行GRADE評價。
結果　激素或聯合免疫抑制劑治療對乙肝相關性腎炎的緩解和蛋白尿的減少沒有作用，再加之其副作用，不推薦使用；單純抗病毒治療已能緩解乙肝相關性腎炎和減少蛋白尿。鑒于干擾素的副作用及價格較為昂貴，宜選擇核苷類病毒逆轉錄酶抑制藥治療。治療中考慮到阿德福韋（Adefovir）和替諾福韋（Tenofovir）的腎毒性，以及拉米夫定長療程存在耐藥可能，經患者同意，我們對其使用博路定（恩替卡韋）0.5 mg qd治療，并繼續采取降壓、護腎、護肝等支持治療。1月后復查，患者24小時尿蛋白降低、血清白蛋白升高、腎功能穩定，乙肝病毒DNA定量降低。
結論　恩替卡韋治療乙肝相關性腎炎伴腎功能衰竭可短期降低24小時尿蛋白、提高血清白蛋白、保持腎功能穩定，降低乙肝病毒DNA定量，長期效果需待進一步觀察。

引用本文： 鄒川,蘇國彬,盧富華,毛煒,劉旭生. 一例乙肝相關性腎炎伴腎功能衰竭患者的循證治療. 中國循證醫學雜志, 2012, 12(3): 360-363. doi: 10.7507/1672-2531.20120058 復制

1.	Zhou YZ, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. Ann Hepatol, 2011, 10(2): 165-173.
2.	Zhang Y, Zhou J H, Yin X L, et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis. World J Gastroenterol, 2010, 16(6): 770-777.
3.	Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis. Aliment Pharmacol Ther, 2006, 24(5): 781-788.
4.	Zhou JH. [Interpretation of the guidelines for diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 596-598.
5.	[Evidence-based guidelines for diagnosis and treatment of common renal diseases in children (for trial) (V): Guidelines for the diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 592-595.
6.	慢性乙型肝炎特殊患者抗病毒治療專家共識. 中國肝臟病雜志(電子版), 2010(1): 44-51.
7.	Lai F M, Tam J S, Li P K, et al. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol, 1989, 414(3): 279-284.
8.	Lai K N, Tam J S, Lin H J, et al. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron, 1990, 54(1): 12-17.
9.	Sayarlioglu H, Erkoc R, Dogan E, et al. Mycophenolate mofetil use in hepatitis B associated-membranous and membranoproliferative glomerulonephritis induces viral replication. Ann Pharmacother, 2005, 39(3): 573.
10.	Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int, 1990, 37(2): 663-676.
11.	Lai K N, Lai FM. Clinical features and the natural course of hepatitis B virus-related glomerulopathy in adults. Kidney Int Suppl, 1991, 35: S40-S45.
12.	Lin CY, Lo SC. Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract. Kidney Int, 1991, 39(2): 301-306.
13.	Lai KN, Li PK, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med, 1991, 324(21): 1457-1463.
14.	Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int, 1995, 47(1): 225-230.
15.	Steiss JO, Piske-Keyser K, Grone HJ, et al. [Treatment of hepatitis B virus-associated membranous glomerulonephritis with interferon alfa in a 7 year old boy]. Klin Padiatr, 2000, 212(5): 283-286.
16.	Kavukcu S, Basdemir G, Eroglu Y, et al. Interferon treatment in hepatitis B virus-associated membranous glomerulopathy. Pediatr Nephrol, 1995, 9(4): 539-540.
17.	Abbas NA, Pitt MA, Green AT, et al. Successful treatment of hepatitis B virus (HBV)-associated membranoproliferative glomerulonephritis (MPGN) with alpha interferon. Nephrol Dial Transplant, 1999, 14(5): 1272-1275.
18.	Dhiman R K, Kohli HS, Das G, et al. Remission of HBV-related mesangioproliferative glomerulonephritis after interferon therapy. Nephrol Dial Transplant, 1999, 14(1): 176-178.
19.	Lopes N E, Lopes L V, Kirsztajn GM, et al. alpha-Interferon therapy for HBV-related glomerulonephritis. Sao Paulo Med J, 1998, 116(5): 1823-1825.
20.	Chung DR, Yang WS, Kim SB, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol, 1997, 17(2): 112-117.
21.	Miranda-Guardiola F, Fernandez-Llama P, Badia JR, et al. Acute renal failure associated with alpha-interferon therapy for chronic hepatitis B. Nephrol Dial Transplant, 1995, 10(8): 1441-1443.
22.	Shapiro RJ, Steinbrecher UP, Magil A. Remission of nephrotic syndrome of HBV-associated membranous glomerulopathy following treatment with interferon. Am J Nephrol, 1995, 15(4): 343-347.
23.	Ueda T, Gotoh Y, Shiroshita K, et al. [Clinical and histological observation of HBV glomerulonephritis treated with interferon-beta]. Nippon Jinzo Gakkai Shi, 1990, 32(11): 1153-1159.
24.	Kawarazaki N, Sano K, Hayashishita N, et al. [A case of hepatitis B virus carrier state with nephrotic syndrome treated with beta interferon]. Nippon Naika Gakkai Zasshi, 1990, 79(5): 682-683.
25.	Lisker-Melman M, Webb D, Di Bisceglie AM, et al. Glomerulonephritis caused by chronic hepatitis B virus infection: treatment with recombinant human alpha-interferon. Ann Intern Med, 1989, 111(6): 479-483.
26.	Garcia G, Scullard G, Smith C, et al. Preliminary observation of hepatitis B-associated membranous glomerulonephritis treated with leukocyte interferon. Hepatology, 1985, 5(2): 317-320.
27.	Conjeevaram HS, Hoofnagle JH, Austin HA, et al. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology, 1995, 109(2): 540-546.
28.	Tang S, Lai FM, Lui YH, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int, 2005,68(4): 1750-1758.
29.	Wen YK, Chen ML. Remission of hepatitis B virus-associated membranoproliferative glomerulonephritis in a cirrhotic patient after lamivudine therapy. Clin Nephrol, 2006,65(3): 211-215.
30.	Chan TM. Hepatitis B and Renal Disease. Curr Hepat Rep, 2010, 9(2): 99-105.
31.	Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology, 2009, 50(3): 661-662.
32.	Peters MG. Special populations with hepatitis B virus infection. Hepatology, 2009, 49(5 Suppl): S146-S155.

1. Zhou YZ, Jie YW, Nan Z. The efficacy of anti-viral therapy on hepatitis B virus-associated glomerulonephritis: A systematic review and meta-analysis. Ann Hepatol, 2011, 10(2): 165-173.
2. Zhang Y, Zhou J H, Yin X L, et al. Treatment of hepatitis B virus-associated glomerulonephritis: a meta-analysis. World J Gastroenterol, 2010, 16(6): 770-777.
3. Fabrizi F, Dixit V, Martin P. Meta-analysis: anti-viral therapy of hepatitis B virus-associated glomerulonephritis. Aliment Pharmacol Ther, 2006, 24(5): 781-788.
4. Zhou JH. [Interpretation of the guidelines for diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 596-598.
5. [Evidence-based guidelines for diagnosis and treatment of common renal diseases in children (for trial) (V): Guidelines for the diagnosis and treatment of HBV-associated glomerulonephritis]. Zhonghua Er Ke Za Zhi, 2010, 48(8): 592-595.
6. 慢性乙型肝炎特殊患者抗病毒治療專家共識. 中國肝臟病雜志(電子版), 2010(1): 44-51.
7. Lai F M, Tam J S, Li P K, et al. Replication of hepatitis B virus with corticosteroid therapy in hepatitis B virus related membranous nephropathy. Virchows Arch A Pathol Anat Histopathol, 1989, 414(3): 279-284.
8. Lai K N, Tam J S, Lin H J, et al. The therapeutic dilemma of the usage of corticosteroid in patients with membranous nephropathy and persistent hepatitis B virus surface antigenaemia. Nephron, 1990, 54(1): 12-17.
9. Sayarlioglu H, Erkoc R, Dogan E, et al. Mycophenolate mofetil use in hepatitis B associated-membranous and membranoproliferative glomerulonephritis induces viral replication. Ann Pharmacother, 2005, 39(3): 573.
10. Johnson RJ, Couser WG. Hepatitis B infection and renal disease: clinical, immunopathogenetic and therapeutic considerations. Kidney Int, 1990, 37(2): 663-676.
11. Lai K N, Lai FM. Clinical features and the natural course of hepatitis B virus-related glomerulopathy in adults. Kidney Int Suppl, 1991, 35: S40-S45.
12. Lin CY, Lo SC. Treatment of hepatitis B virus-associated membranous nephropathy with adenine arabinoside and thymic extract. Kidney Int, 1991, 39(2): 301-306.
13. Lai KN, Li PK, Lui SF, et al. Membranous nephropathy related to hepatitis B virus in adults. N Engl J Med, 1991, 324(21): 1457-1463.
14. Lin CY. Treatment of hepatitis B virus-associated membranous nephropathy with recombinant alpha-interferon. Kidney Int, 1995, 47(1): 225-230.
15. Steiss JO, Piske-Keyser K, Grone HJ, et al. [Treatment of hepatitis B virus-associated membranous glomerulonephritis with interferon alfa in a 7 year old boy]. Klin Padiatr, 2000, 212(5): 283-286.
16. Kavukcu S, Basdemir G, Eroglu Y, et al. Interferon treatment in hepatitis B virus-associated membranous glomerulopathy. Pediatr Nephrol, 1995, 9(4): 539-540.
17. Abbas NA, Pitt MA, Green AT, et al. Successful treatment of hepatitis B virus (HBV)-associated membranoproliferative glomerulonephritis (MPGN) with alpha interferon. Nephrol Dial Transplant, 1999, 14(5): 1272-1275.
18. Dhiman R K, Kohli HS, Das G, et al. Remission of HBV-related mesangioproliferative glomerulonephritis after interferon therapy. Nephrol Dial Transplant, 1999, 14(1): 176-178.
19. Lopes N E, Lopes L V, Kirsztajn GM, et al. alpha-Interferon therapy for HBV-related glomerulonephritis. Sao Paulo Med J, 1998, 116(5): 1823-1825.
20. Chung DR, Yang WS, Kim SB, et al. Treatment of hepatitis B virus associated glomerulonephritis with recombinant human alpha interferon. Am J Nephrol, 1997, 17(2): 112-117.
21. Miranda-Guardiola F, Fernandez-Llama P, Badia JR, et al. Acute renal failure associated with alpha-interferon therapy for chronic hepatitis B. Nephrol Dial Transplant, 1995, 10(8): 1441-1443.
22. Shapiro RJ, Steinbrecher UP, Magil A. Remission of nephrotic syndrome of HBV-associated membranous glomerulopathy following treatment with interferon. Am J Nephrol, 1995, 15(4): 343-347.
23. Ueda T, Gotoh Y, Shiroshita K, et al. [Clinical and histological observation of HBV glomerulonephritis treated with interferon-beta]. Nippon Jinzo Gakkai Shi, 1990, 32(11): 1153-1159.
24. Kawarazaki N, Sano K, Hayashishita N, et al. [A case of hepatitis B virus carrier state with nephrotic syndrome treated with beta interferon]. Nippon Naika Gakkai Zasshi, 1990, 79(5): 682-683.
25. Lisker-Melman M, Webb D, Di Bisceglie AM, et al. Glomerulonephritis caused by chronic hepatitis B virus infection: treatment with recombinant human alpha-interferon. Ann Intern Med, 1989, 111(6): 479-483.
26. Garcia G, Scullard G, Smith C, et al. Preliminary observation of hepatitis B-associated membranous glomerulonephritis treated with leukocyte interferon. Hepatology, 1985, 5(2): 317-320.
27. Conjeevaram HS, Hoofnagle JH, Austin HA, et al. Long-term outcome of hepatitis B virus-related glomerulonephritis after therapy with interferon alfa. Gastroenterology, 1995, 109(2): 540-546.
28. Tang S, Lai FM, Lui YH, et al. Lamivudine in hepatitis B-associated membranous nephropathy. Kidney Int, 2005,68(4): 1750-1758.
29. Wen YK, Chen ML. Remission of hepatitis B virus-associated membranoproliferative glomerulonephritis in a cirrhotic patient after lamivudine therapy. Clin Nephrol, 2006,65(3): 211-215.
30. Chan TM. Hepatitis B and Renal Disease. Curr Hepat Rep, 2010, 9(2): 99-105.
31. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology, 2009, 50(3): 661-662.
32. Peters MG. Special populations with hepatitis B virus infection. Hepatology, 2009, 49(5 Suppl): S146-S155.

《中國循證醫學雜志》

一例乙肝相關性腎炎伴腎功能衰竭患者的循證治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

《中國循證醫學雜志》

一例乙肝相關性腎炎伴腎功能衰竭患者的循證治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

上一篇

下一篇

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料