奈玛特韦/利托那韦影响COVID-19患者肝肾功能的真实世界研究OA
Real-world study on the effects of Nirmatrelvir/Ritonavir on liver and kidney function in COVID-19 patients
目的 本研究旨在探讨奈玛特韦/利托那韦治疗对新型冠状病毒感染(coronavirus disease 2019,COVID-19)患者肝肾功能的实际影响,为临床治疗提供科学依据,确保患者用药安全性.方法 收集2022年10月至2025年2月期间在广西壮族自治区民族医院接受奈玛特韦/利托那韦治疗的COVID-19患者的临床资料.根据患者治疗前的肝肾功能进行亚组分析.采用t检验,χ2检验及非参数检验比较患者治疗前和治疗后3、7、14、21d的肝功能指标和肾功能指标差异.结果 共纳入106例接受奈玛特韦/利托那韦治疗的COVID-19患者,其中,男65例,女41例.肝功能监测的亚组分析显示,肝功能正常患者治疗后14d、21d的γ-谷氨酰转肽酶水平较治疗前明显增高(P<0.05);轻度肝损伤患者治疗后3d的天冬氨酸转氨酶水平显著低于治疗前(P<0.05).肾功能监测显示,在30ml/(min·1.73m2)<估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)≤60ml/(min·1.73m2)组中,治疗后7d的血尿素氮(urea nitrogen,URea)水平显著低于治疗前(P<0.05).在60ml/(min·1.73m2)<eGFR≤90ml/(min·1.73m2)组中,治疗后7d的血清肌酐较治疗前有所减少(P<0.05).在eGFR>90ml/(min·1.73m2)组中,与治疗前相比,患者治疗后14d的URea水平明显降低,差异有统计学意义(P<0.05).结论 奈玛特韦/利托那韦对COVID-19患者具有良好的肝肾安全性.在权衡利弊后,肝肾功能不全的COVID-19患者可考虑使用奈玛特韦/利托那韦治疗,用药期间应进行肝肾功能监测.奈玛特韦/利托那韦对严重肝肾功能不全患者的影响仍需进一步明确.
Objective The purpose of this study is to explore the actual effects of Nirmatrelvir/Ritonavir treatment on liver and kidney function in coronavirus disease 2019(COVID-19)patients,in order to provide scientific basis for clinical treatment and ensure the safety of medication for patients.Methods Collect clinical data of COVID-19 patients treated with Nirmatrelvir/Ritonavir at Minzu Hospital of Guangxi Zhuang Autonomous Region from October 2022 to February 2025.Perform subgroup analysis based on the patient's liver and kidney function before treatment.Using t-test,chi square test,and non-parametric test to compare the differences in liver and kidney function indicators between patients before treatment and 3,7,14,and 21 days after treatment.Results A total of 106 COVID-19 patients receiving treatment with Nirmatrelvir/Ritonavir were included.Among them,there were 65 male patients and 41 female patients.In terms of liver function monitoring,subgroup analysis showed that the levels of gamma-glutamyl transferase in patients with normal liver function were significantly increased at 14 and 21 days after treatment compared to before treatment(P<0.05).In patients with mild liver injury,the level of aspartate aminotransferase after 3 days of treatment was significantly lower than before treatment(P<0.05).In terms of renal function monitoring,in group with 30ml/(min·1.73m2)<estimated glomerular filtration rate(eGFR)≤60ml/(min·1.73m2),the blood urea nitrogen(URea)levels after 7 days of treatment were significantly lower than before treatment(P<0.05).In group of 60ml/(min·1.73m2)<eGFR≤90ml/(min·1.73m2),serum creatinine(Creat)decreased after 7 days of treatment compared to before treatment(P<0.05).In eGFR>90ml/(min·1.73m2)group,the URea level of patients significantly decreased after 14 days of treatment compared to before treatment,and the difference was statistically significant(P<0.05).Conclusion Nirmatrelvir/Ritonavir has good liver and kidney safety for COVID-19 patients.After weighing the pros and cons,COVID-19 patients with liver and kidney dysfunction may consider using Nirmatrelvir/Ritonavir for treatment,and liver and kidney function monitoring should be conducted during medication.However,the impact of Nirmatrelvir/Ritonavir on patients with severe liver and kidney dysfunction still needs further clarification.
曾尚勇;陆海鹏;吕聪;李嘉乐;黄小理
广西壮族自治区民族医院药学部,广西 南宁 530001广西壮族自治区民族医院药学部,广西 南宁 530001广西壮族自治区民族医院药学部,广西 南宁 530001广西壮族自治区民族医院药学部,广西 南宁 530001广西壮族自治区民族医院药学部,广西 南宁 530001
医药卫生
奈玛特韦/利托那韦COVID-19肝功能肾功能
Nirmatrelvir/RitonavirCOVID-19Liver functionRenal function
《中国现代医生》 2026 (9)
47-51,5
广西壮族自治区卫生健康委员会科研课题(Z-F20231699)
评论