摘要
目的评估HBsAg水平变化对聚乙二醇干扰素(PEG-IFNα-2a)治疗HBeAg阴性慢性乙型肝炎疗效预测价值。方法 HBeAg阴性慢性乙型肝炎患者,采用PEG-IFNα-2a每次180μg,皮下注射,每周1次治疗,疗程48周。Architect HBsAg定量检测系统检测HBsAg,实时荧光定量PCR法检测HBV DNA定量。以治疗24周时HBsAg下降1 lg IU/ml为临界点,比较高于临界点和低于临界点患者持续病毒学应答率差异,分别计算持续病毒学应答(SVR)的阳性预测值、阴性预测值和符合率。结果完成48周疗程61例。其中有43例(70.5%)在48周疗程结束时获得病毒学应答;随访24周,有23例(37.7%)患者获得SVR,20例复发。获得SVR患者HBsAg基线水平低于非SVR患者(P<0.05)。获得SVR患者在治疗24周时HBsAg下降幅度较复发及无应答患者显著(P<0.05)。治疗24周时HBsAg下降≥1 lg IU/ml对获得SVR的阳性预测值为95.5%,阴性预测值为94.9%,符合率为95.1%。结论对于应用PEG-IFNα-2a治疗的HBeAg阴性慢性乙型肝炎患者,治疗前HBsAg的水平以及治疗24周HBsAg的下降幅度是推断治疗应答状况的有效预测指标。
Objective To explore the value of serum HBsAg quantification in predicting response of PEG-IFNγ-2a in the treatment of patients with HBeAg-negative chronic hepatitis B （CHB）. Methods Patients diag- nosed as HBeAg-negative CHB were given PEG-IFNγ-2a （180μg/week, subcutaneously） once a week for a period of 48 weeks. The Abbott Architect HBsAg QT assay and realtime fluorescence quantitative PCR were used to evaluate the amount of HBsAg and the expression levels of HBV. Rates of sustained virological response （SVR） were compared between patients showing a decease of serum I-IBsAg level ≥11 gIU/ml and ≤ 11 gIU/ml at week 24 of PEG-IFNγ-2a therapy. The positive predictive value （PPV）, negative predictive value （NPV） and coincidence rate were calculated by statistical method. Results Of all 61 patients, 43 （70.5%） showed an end of treatment response at week 48. Twen- W-four weeks after cessation, 23 patients （37.7%） achieved SVR, while 20 patients relapsed. Baseline serum HBsAg level was lower in patients who developed SVR comparing with in patients who did not. Patients who developed SVR showed a marked decrease in serum HBsAg at week 24. The cutoff of 1 1gIU/ml HBsAg decrease had a PPV of 95.5%, the NPV of 94.9%, and coincidence rate of 95.1% at week 24. Conclusion The results suggest that low base- line serum HBsAg level and a marked decease of serum HBsAg level at week 24 may be used to predict better re- sponse in patients of HBeAg-negative CHB under PEG-IFNγ-2a treatment.
出处
《海南医学》
CAS
2013年第19期2818-2820,共3页
Hainan Medical Journal
基金
广东省佛山市卫生局课题资助项目(编号:2011098)
