核苷(酸)类抗病毒药物对HBV感染者早期肾功能的影响

Effect of Nucleos(t)ide Analog Antiviral Drugs on Early Renal Function in Patients with HBV Infection

摘要: 核苷(酸)类抗病毒药物是慢性乙型肝炎病毒感染治疗的核心药物，通过强效抑制HBV DNA复制，可显著降低病毒载量、延缓肝脏疾病进展，进而改善患者长期临床预后。然而，尽管其抗病毒疗效显著，长期应用仍可能对部分患者的肾功能产生潜在影响，成为临床治疗中需重点关注的安全性问题。文章探讨了不同核苷(酸)类药物对肾功能的影响差异，以及如何通过早期监测、优化给药方案来保护肾功能，降低肾毒性风险。综上，核苷(酸)类药物在HBV感染治疗中不可或缺，但其潜在的肾损伤需引起足够重视。临床医师应在治疗初始阶段充分权衡其疗效与肾毒性风险，结合患者基础肾功能、合并疾病等个体情况制定个性化的方案，治疗全程需坚持定期肾功能监测，根据监测结果及时优化用药策略，通过精细化管理在保障抗病毒疗效的同时，最大限度降低肾损伤风险，实现安全、有效的长期治疗目标。

Abstract: Nucleos(t)ide analogues (NAs) are the core drugs for the treatment of chronic hepatitis B virus infection. By strongly inhibiting HBV DNA replication, they can significantly reduce viral load, delay the progression of liver disease, and improve the long-term clinical prognosis of patients. However, despite its significant antiviral efficacy, long-term application may still have a potential impact on the renal function of some patients, which has become a safety issue that needs to be focused on in clinical treatment. This paper discusses the differences in the effects of different Nucleos(t)ide analogues on renal function and how to protect renal function and reduce the risk of nephrotoxicity through early monitoring and optimized dosing regimens. In summary, Nucleos(t)ide analogues are indispensable in the treatment of HBV infection, but their potential renal damage needs to be paid enough attention. Clinicians should fully weigh the efficacy and risk of nephrotoxicity in the initial stage of treatment, and formulate personalized plans based on the individual conditions of patients’ basic renal function and comorbidities. Regular renal function monitoring should be adhered to throughout the treatment, and the medication strategy should be optimized in a timely manner according to the monitoring results. Through refined management, the risk of renal injury can be minimized while ensuring antiviral efficacy, so as to achieve safe and effective long-term treatment goals.