长期服用核苷酸类药物致肾损伤的慢性乙型肝炎与患者尿KIM-1及Netrin-1水平的关系-东南大学学报医学版

长期服用核苷酸类药物致肾损伤的慢性乙型肝炎与患者尿KIM-1及Netrin-1水平的关系

单位：衡水市人民医院, 河北衡水 053000

分类号：R512.62;R691.6

出版年·卷·期（页码）：2019·38·第二期（351-354）

摘要：

目的：探讨长期服用核苷酸类药物致肾损伤的慢性乙型肝炎与患者尿神经导向因子（Netrin）-1及肾损伤因子（KIM）-1水平的关系。方法：随机选取我院诊治的47例长期服用核苷酸类药物的慢性乙型肝炎患者作为观察组，另选取同期于我院诊治未应用核苷酸类药物进行抗病毒治疗的53例患者作为对照组。对患者进行随访调查，观察两组的尿Netrin-1、KIM-1、血清尿素氮、血清肌酐、肾小球滤过率等变化情况。结果：阿德福韦酯以及替诺福韦酯治疗的患者在长期用药下出现明显肾损伤，出现肾损伤患者Netrin-1、KIM-1均明显高于对照组，且随着肾损伤的加重，Netrin-1、KIM-1水平均明显上升（P<0.05）。经过多因素回归分析，Netrin-1、KIM-1与肾损伤呈正相关。结论：尿Netrin-1、KIM-1水平随着肾损伤的加重明显上升，在多因素分析下其与肾损伤呈正相关的关系。

Objective:To discuss the relationship between chronic hepatitis B of kidney injury caused by long-term use of nucleotide drugs and urinary neuronal guidance factor (Netrin)-1, urinary kidney injury molecule (KIM)-1 levels. Methods:Forty-seven patients with chronic hepatitis B who had been taking nucleotides for a long time were randomly selected as the observation group. In addition, 53 patients who were treated with anti-viral therapy without nucleotide drugs in our hospital were selected as the control group. The patients were followed up and the changes of urine Netrin-1, KIM-1, serum urea nitrogen, serum creatinine and glomerular filtration rate were observed in the two groups. Results:Patients treated with adefovir dipivoxil and tenofovir disoproxil showed significant renal injury under long-term use. Netrin-1 and KIM-1 levels of patients with renal injury in the observation group were significantly higher than those in the control group. With the severity of renal injury, Netrin -1, KIM-1 levels were significantly increased (P<0.05). After multivariate regression analysis, Netrin-1 and KIM-1 levels were positively correlated with renal injury. Conclusion:The urinary Netrin-1 and KIM-1 levels show significant increase with the severity of renal injury. Under multivariate analysis, it was positively correlated with renal injury.

参考文献：

[1] 龚世梅,舒发明,冯全生.中药联合抗病毒治疗慢性乙型肝炎肝纤维化研究概述[J].亚太传统医药,2016,12(9):69-71.
[2] 李世军.改善全球肾脏病预后组织(KDIGO)临床实践指南:肾小球肾炎[J].肾脏病与透析肾移植杂志,2012,21(3):260-267.
[3] 刘建峰,华琦,罗鸿宇,等.老年原发性高血压患者红细胞分布宽度与早期肾功能损害的相关性分析[J].中国心血管杂志,2015(4):256-261.
[4] 周萍,王聪,王晓琴,等.乙肝患者血清标志物与肝纤维化血清学指标的相关性分析[J].现代生物医学进展,2017,17(7):1350-1352.
[5] 陈琼,陈蓉,曾艺馨,等.乙型肝炎病毒感染患者HBV-DNA载量与血清及肝纤维化标志物的关系[J].中华医院感染学杂志,2017,27(15):3487-3489.
[6] 王文君,宋予苹.肾功能不全对慢性心力衰竭老年患者病死率和心衰再住院率的影响[J].现代医学,2016,44(7):984-986.
[7] 向姝,乔旭霞,罗海霞,等.重庆市巴南区体检人群高尿酸血症患病率现状调查及与血脂相关性的研究[J].现代医学,2016,44(5):649-652.
[8] 曹晓燕,张惠荣,章伟,等.尿神经导向因子-1和肾损伤分子-1对窒息后新生儿急性肾损伤的诊断价值探讨[J].中国当代儿科杂志,2016,18(1):24-28.
[9] 张雷,柯斯奇.尿神经导向因子-1与肾损伤因子-1联合检测在成人急性肾损伤早期诊断中的价值[J].中国老年学,2016,36(10):2481-2482.
[10] 祁洁,王钊华,赵鸿斌,等.尿NGAL、KIM-1和IL-18联合检测对儿童急性肾损伤早期诊断的价值[J].海南医学,2017,28(11):1779-1781.
[11] 李萍,王丽,胡蓉,等.血清纤维化标志物和肝功能指标在慢性乙型肝炎患者肝纤维化诊断中的价值[J].疑难病杂志,2017,16(6):575-578.
[12] CAO X Y,ZHANG H R,ZHANG W,et al.Diagnostic values of urinary netrin-1 and kidney injury molecule-1 for acute kidney injury induced by neonatal asphyxia[J].Chinese Journal of Contemporary Pediatrics,2016,18(1):24-28.
[13] 李鉴峰,韩宏光,李晓密,等.神经轴突导向因子1裸质粒转染对5/6肾切除模型大鼠肾脏管周毛细血管网的影响[J].中国组织工程研究,2015,19(24):3824-3831.
[14] 曲云东,叶茜,王磊,等.39例阿德福韦酯相关肾性低磷血症及骨软化症临床分析和初步转归[J].中华传染病杂志,2015,33(11):678-681.
[15] 徐勇,冯继红.核苷(酸)类似物对慢性乙型肝炎患者肾功能的影响[J].药物不良反应杂志,2016,18(1):35-40.
[16] 徐勇,冯继红.核苷和核苷酸类药物对慢性乙型肝炎患者肾小球滤过率和血肌酐水平的影响[J].临床肝胆病杂志,2016,32(2):279-283.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录