| Objective:Nucleos（t）ide Analogs（NAs）: entecavir（ETV）,tenofovir disoproxil fumarate（TDF）,and tenofovir alafenamide（TAF）are the preferred agents for controlling chronic hepatitis B（CHB）.All the three drugs can express good antiviral efficacy to control the condition of patients with CHB.However,NAs have certain renal toxicity,and the early manifestation may be renal tubular dysfunction.Therefore,the long-term renal adverse reactions induced by NAs cannot be ignored by clinical doctors.When necessary,the drugs should be adjusted according to the patient’s condition and the drugs with low renal toxicity should be selected to continue the treatment.The purpose of this study was to compare the anti-HBV efficacy of ETV,TDF,and TAF,as well as the renal safety of the three drugs,to further explore the advantages and disadvantages of the three NAs in the antiviral treatment,so as to guide clinical medication more scientifically.In addition,the sensitivity of several renal markers indicating NAs-induced renal injury was compared,which would help clinicians to identify the side effects of NAs in the early stage.Methods:68 patients with CHB who admitted to our Hospital from September 2019 to May 2021were divided into ETV group（n=22）,TDF group（n=26）and TAF group（n=20）by the different treatments.All CHB patients met the indications of HBV treatment,and began to use NAs drugs after eliminating contraindications.The general information of patients’ age,gender,drugs used,and the baseline at the beginning of treatment were recorded.The serum creatinine,estimated glomerular filtration rate（e GFR）,urine retinol-binding protein（RBP）,urine cystatin C（Cys-C）,urine N-acetyl-β-D-glucosidase（NAG）,urine α1-microglobulin（α1-MG）and urine β2-microglobulin（β2-MG）were observed and compared after 24±2 weeks of treatment.Results:1.There was no significant difference in serum ALT among the three groups before NAs treatment.After 24±2 weeks of NAs treatment,there was no significant difference in the normalization rate of ALT among the three groups（P>0.05）.Considering that ETV,TDF and TAF can improve liver function and protection.There was no significant difference.2.There was no significant difference in HBV and HBs Ag among the three groups before NAs treatment.After 24±2 weeks of NAs treatment,all patients in the three groups showed a decrease in HBs Ag.Considering that ETV,TDF and TAF have strong anti-HBV effects similarly。3.There were no significant differences in s Cr,e GFR,urine RBP,urine NAG,urine Cys-C,and urine β2-MG in the first three groups of patients treated with NAs;there were no significant differences in s Cr,e GFR,urine RBP,urine NAG,urine Cys-C,and urine β2-MG in the three groups after the treatment of NAs for 24 ±2 weeks（P>0.05）.There was a significant difference in urine α1-MG（P<0.05）.Multiple comparisons suggest that urine α1-MG in the TDF group was significantly higher than that in the TAF group（P<0.05）.Conclusions:1.The three NAs antiviral drugs can effectively control the liver inflammation caused by HBV,and have a good inhibitory effect on the replication of HBV.2.The kidney safety of ETV,TDF and TAF is not the same.This study suggests that TAF has better renal safety than TDF,and the difference is significant.α1-MG is more sensitive than other indicators for patients with CHB who requiring long-term use of NAs.Regular detection of urine α1-MG in CHB patients with NAs can detect renal damage in time and further guide clinical medication. |
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