摘要
目的探讨聚乙二醇干扰素（Peg-IFN）α-2a个体化治疗慢性乙型肝炎（CHB）患者的临床疗效。方法对92例慢性乙型肝炎患者给予Peg-IFN10-2a180ug每周1次皮下注射。将12周HBVDNA仍为阳性的患者分为延长疗程（72周）组、联合核昔（酸）类似物（恩替卡韦或阿德福韦酯）组及常规治疗（48周）组。在治疗前、个体化治疗后12、24、36周以及停药后随访24周分别检测HBV基因型（PeR微板核酸杂交酶联免疫法）、HBVDNA载量（实时荧光定量PCR法）、HBsAg定量（Elecsys Ⅱ检测系统），观察并比较各组患者病毒学应答及HBsAg水平下降情况，并分析影响疗效的因素。各组数据间比较采用t检验或x^2检验，影响因素采用logistic回归法分析。结果延长疗程组的持久病毒学应答（SVR）率（78．3％，18／23）明显高于常规治疗组（38．1％，8／21），X^2=7．33，P〈0．05；随访24周时的HBsAg水平平均下降幅度[（0．7±0．6）log10 IU／ml]也高于常规治疗组[（0．4±0．3）log10IU／ml，t=2．11，P〈0．051。联合恩替卡韦及阿德福韦酯组随访至24周时HBVDNA水平平均下降幅度分别达到（3．9±1．1）log10拷贝／rnl及（3．7±1．3）log10拷贝／ml，明显大于常规治疗组（t值分别为8．45和6．31，P值均〈0．05），且该两组SVR率分别达到83．3％（15／18）及85．7％（12／14），也明显高于常规治疗组（z。值分别为8．20和7．78，尸值均〈0．05）；HBsAg水平平均下降幅度分别为（0．8±0．5）log10IU／ml和（0．9±0．3）log10IU／m1，均明显高于常规治疗组[（0．4士0．3）log10 IU／ml，t值分别为3．05和4．58，P值均〈0．051。Logistic回归分析显示HBV DNA载量和C基因型是影响病毒学应答的主要因素。结论Peg-IFNα-2a抗病毒治疗早期应答不佳的患者可通过延长疗程至72周或联合恩替卡韦、阿德福韦酯等核苷（酸）类似物进行个体化治疗，�
Objective To evaluate antiviral effects of Peg-IFNα-2a in patients with chronic hepatitis B. Methods 92 chronic hepatitis B patients were enrolled to receive the treatment with Peg-IFNα-2a 180μg subcutaneous injection once weekly. The patients who did not get early response were divided into 3 groups： group 1, extend the treatment to 72 weeks; group 2, combined with nucleot（s）ide analogue （entecavir or adefovir） treatment; group 3, continue the treatment until 48 weeks. HBV DNA and quantitative HBsAg were assessed at baseline, week12, 24,36 and after 24 weeks follow-up. Results Patients in group 1 had significantly higher SVR rate （78.3%） than patients in group 3 （38.1%, x^2= 7.33, P 〈 0.05）. The mean reduction of HBsAg in group 1 at 24 weeks of post-treatment follow up was higher than that in group 3 （ t =2.11, P 〈 0.05）. In group 2 the mean reductions of HBV DNA at 24 weeks of post-treatment follow up were （3.9±1.1） log10 copy/ml and （3.7±1.3） log10 copy/ml respectively with combination of entecavir or adefovir, both of which were significantly higher than that in group 3（ t = 8.45 and 6.31, P 〈 0.05）; the SVR rates in the entecavir group and the adefovir group （83.3% and 85.7%, respectively） were significantly higher than that in group 3 （ x^2 = 8.20 and 7.78, P 〈 0.05）; the mean reductions of HBsAg in the entecavir group and the adefovir group [（0.8±0.5） log10 IU/ml and （0.9±：0.3） log10 IU/ml, respectively ] were significantly greater than group 3[ （0.4±0.3） log10 IU/ml, t = 3.05 and 4.58,P 〈 0.05]. The level ofHBV DNA and C genotype were the main predictors of response. Conclusion Individualizing therapy by prolonging the duration of Peg-IFNα-2a treatment to 72 weeks or adding nucleoside analogues such as entecavir and adefovir in patients without early response may substantially increase the SVR rate and lead to the decrease of HBsAg.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2011年第9期670-673,共4页
Chinese Journal of Hepatology
关键词
肝炎
乙型
慢性
治疗结果
干扰素Α
Hepatitis B, chronic
Treatment outcome
Interferon-alpha
