摘要
目的评估基线HBsAg定量值对聚乙二醇干扰素α-2b(PEG-IFNα-2b)治疗低水平HBsAg慢性乙型肝炎(CHB)患者HBsAg清除的预测价值。方法选取2016年3月-2018年9月于吉林省肝胆病医院接受核苷酸类似物治疗达到HBV DNA<20 IU/ml、ALT水平正常、0.05 IU/ml<HBsAg定量<1500 IU/ml,序贯PEG-IFNα-2b治疗的HBeAg阴性CHB患者51例。收集基线及治疗12、24、36、48周时血清HBsAg定量、抗-HBs定量、HBV DNA定量、ALT检测结果。治疗48周时,出现HBsAg清除为应答组(19例),HBsAg未清除为非应答组(32例)。非正态分布的计量资料两组间比较采用Mann-Whitney U检验。采用受试者工作曲线(ROC曲线)分析基线HBsAg定量对治疗48周HBsAg清除的预测价值。结果PEG-INFα-2b治疗48周时HBsAg清除19例(37.25%),其中基线HBsAg定量≤10 IU/ml者7例、10 IU/ml<HBsAg定量≤100 IU/ml者9例、100 IU/ml<HBsAg定量≤500 IU/ml、500 IU/ml<HBsAg定量≤1000 IU/ml及1000 IU/ml<HBsAg定量≤1500 IU/ml各1例;HBsAg血清学转换8例(15.69%),其中10 IU/L<抗-HBs≤100 IU/L 4例,100 IU/L<抗-HBs≤500 IU/L 3例,抗-HBs>500 IU/L 1例。应答组基线HBsAg定量明显低于非应答组[16.38(2.25~61.62)IU/ml vs 363.73(110.14~927.72)IU/ml],差异有统计学意义(Z=-4.442,P<0.001)。治疗12、24周两组血清ALT水平均升高,应答组与非应答组比较差异有统计学意义[82.00(55.00~123.00)U/L vs 49.00(34.00~65.00)U/L、78.00(46.00~88.00)U/L vs 48.08(29.79~71.75)U/L,Z值分别为-2.286、-2.617,P值均<0.05]。PEG-INFα-2b治疗12、24周时,应答组HBsAg水平下降幅度明显高于非应答组[91.77(49.62~99.28)%vs 44.03(15.75~68.90)%,99.00(98.00~100.00)%vs 77.94(37.02~89.60)%,Z值分别为-3.312、-5.100,P值均<0.05]。停药随访24周19例HBsAg清除者均维持应答,HBsAg血清学转换7例。ROC曲线分析结果显示,基线HBsAg水平可预测治疗48周HBsAg的清除率,其最佳预测值为86.36 IU/ml,ROC曲线下面积为0.875(95%可信区间:0.764~0.986),敏感度和特异度分别为84.4%�
Objective To investigate the value of baseline HBsAg quantification in predicting HBsAg clearance in pegylated interferonα-2b(PEG-INFα-2b)-treated chronic hepatitis B(CHB)patients with a low level of HBsAg.Methods A retrospective analysis was performed for 51 HBeAg-negative CHB patients who achieved HBV DNA<20 IU/ml after nucleos(t)ide analogue(NA)treatment,had a normal level of alanine aminotransferase(ALT)and an HBsAg quantification of>0.05 IU/ml and<1500 IU/ml,and received sequential PEG-INFα-2b treatment in Hepatobiliary Hospital of Jilin from March 2016 to September 2018.The clinical data of serum HBsAg quantification,anti-HBs quantification,HBV DNA quantification,and ALT level were collected at baseline and at weeks 12,24,36,and 48 of treatment.At week 48 of treatment,19 patients with HBsAg clearance were enrolled as response group,and 32 patients without HBsAg clearance were enrolled as non-response group.The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups,and the receiver operating characteristic(ROC)curve was used to analyze the value of baseline HBsAg quantification in predicting HBsAg clearance at week 48 of treatment.Results At week 48 of treatment,19 patients(37.25%)achieved HBsAg clearance,among whom 7(7/19,36.84%)had a baseline HBsAg quantitation of≤10 IU/ml,9(9/19,47.37%)had a baseline HBsAg quantitation of>10 IU/ml and≤100 IU/ml,1 had a baseline HBsAg quantitation of>100 IU/ml and≤500 IU/ml,1 had a baseline HBsAg quantitation of>500 IU/ml and≤1000 IU/ml,and 1 had a baseline HBsAg quantitation of>1000 IU/ml and≤1500 IU/ml;8 patients(15.69%)achieved HBsAg seroconversion,among whom 4 had an anti-HBs level of>10 IU/L and≤100 IU/L,3 had an anti-HBs level of>100 IU/L and≤500 IU/L,and 1 had 500 IU/L.The response group had a significantly lower baseline HBsAg quantitation than the non-response group[16.38(2.25-61.62)IU/ml vs 363.73(110.14-927.72)IU/ml,Z=-4.442,P<0.001].At weeks 12 and 24 of treatment,both groups had an increase i
作者
陈曦
赵文静
孙岩
殷海燕
CHEN Xi;ZHAO Wenjing;SUN Yan;YIN Haiyan(Seventh Treatment Ward of Hepatology,Hepatobiliary Hospital of Jilin,Changchun 130062,China;Department of Clinical Research,Hepatobiliary Hospital of Jilin,Changchun 130062,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2020年第8期1723-1726,共4页
Journal of Clinical Hepatology
基金
吉林省卫生服务能力提升项目(2017F004)。
