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  【摘要】 目的 拉米夫定耐药对乙肝病毒相关性肾炎治疗的影响。 方法 36例HBV相关性肾炎患者同时使用激素及拉米夫定治疗,24周时HBVDNA定量较治疗前下降分为A组23例,上升或不变设为B组13例,测定治疗前及治疗24周、48周时的24 h尿蛋白定量,肝肾功能,HBV-DNA定量。 结果 治疗48周后两组尿蛋白定量下降,血浆白蛋白升高,与治疗前比较差异有统计学意义(P0.05);两组治疗前后及两组间血肌酐、谷丙转氨酶比较差异无统计学意义(P>0.05)。 结论 24周时拉米夫定耐药的乙肝病毒相关性肾炎患者继续单用该药,仍能取得较好疗效。

 【关键词】 乙肝病毒相关性肾病;拉米夫定;耐药

 Analysis of lamivudine resistance in hepatitis B virus associated-glomerulonephritis patients with therapy of lamivudine plus steroid

 ZENG Chun, YE Kun, ZENG Xi,et al.

 Department of Nephrology, GuangXi People’s Hospital, Nanning 530021, China

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 【Abstract】 Objective To evaluate the influence of lamivudine resistance on hepatitis B virus associated-glomerulonephritis (HBV-GN) therapy. Methods 36 patients with HBV-GN were enrolled into combination therapy of lamivudine plus steroid. 24 Cases whose HBV-DNA sequences decreased after 24-week lamivudine treatment were divided into A group, 13 cases into B group otherwise. Protein in urine per day, liver and renal function, as well as HBV-DNA sequences were detected prior to treatment, after 24-week treatment and 48-week treatment respectively. Results Compared to the figures prior to treatment, quantity of protein in urine dropped significantly and serum albumin level increased significantly after 48-week treatment in either A or B group. Nevertheless, there was no significance when data in two groups were compared to each other. There was no significance when Serum creatine and glutamic-pyruvic transaminase in each group were compared before and after therapy, and data in two groups were compared to each other. Conclusion Comparatively satisfactory outcome might be expected in lamivudine-resistant patients with HBV-GN when medicine continued. 

 【Key words】 Hepatitis B virus associated-nephritis; Lamivudine; Resistance

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 作者单位:530021广西壮族自治区人民医院肾内科

 乙肝病毒相关性肾炎临床表现为肾病综合征时主张使用肾上腺皮质激素,且同时使用拉米夫定避免激素诱发乙肝病毒复制已成共识,但拉米夫定的耐药是否会影响乙肝相关性肾炎的治疗国内文献鲜见报道。本文总结我科2005年1月至2009年7月确诊为乙型肝炎病毒相关性肾炎且同时使用激素及拉米夫定的患者的临床资料进行分析,旨在了解使用激素时拉米夫定的耐药对治疗的影响。

 1 临床资料

 1.1 一般资料 本组所有患者均为乙肝病毒相关性肾炎,共36例,其中男25例,女11例,男女之比为2 ......