普通IFN-α治疗慢性乙型肝炎发生HBeAg血清学转换的预测因素分析

发布时间：2018-04-11 09:59

  本文选题：肝炎 + 干扰素　； 参考：《安徽医科大学》2014年硕士论文

【摘要】：目的观察慢性乙型肝炎（CHB）患者接受普通干扰素（IFN）治疗后不同时期的外周血ALT、HBV DNA、HBsAg、HBeAg滴度的变化，并探讨其与治疗结束后HBeAg血清学应答之间的关系。 方法对115例使用普通干扰素治疗的HBeAg阳性CHB患者在其知情同意的情况下随访48周，分别于抗病毒治疗的基线（0周）、12周、24周、48周时收集患者的血清，定量检测HBsAg、HBeAg、HBV DNA、ALT水平。并分析治疗基线时相关指标的水平及治疗后不同时期（12周、24周）时外周血的ALT、HBV DNA、HBsAg、HBeAg滴度变化与IFN治疗HBeAg阳性CHB患者发生HBeAg血清学应答之间的关系。 结果抗病毒治疗48周后，初始时115例患者接受普通干扰素治疗，，其中失访14例，治疗中换或（联合）核苷类似物治疗18例，临床资料不完善4例，未能完成48周的基本疗程7例。共剩余72例完成48周的IFN治疗，其中28例患者发生HBeAg血清学转换，44例患者HBeAg仍为阳性。在获得HBeAg血清学转换与未获得血清学转换的患者中治疗基线（0周）时ALT水平及HBeAg滴度的差异有统计学意义。IFN治疗12周、24周的HBV DNA、HBeAg、HBsAg滴度水平分别小于6.511g copies/ml、3.831g copies/ml，2.38lg S/CO、0.87lg S/CO，4.33IU/ml、4.07IU/ml时治疗结束后HBeAg血清学转换率高。12周时HBV DNA下降较基线时超过27%，12周、24周时HBeAg水平下降率超过71%、95%及HBsAg较基线下降超过65%、47%时能较好的预测治疗结束时HBeAg血清学转换率。 结论HBeAg阳性CHB患者在接受普通IFN治疗时可根据基线时ALT、HBeAg水平预测其治疗48周后的HBeAg血清学转换率，同时治疗后动态观察HBV DNA、HBeAg、HBsAg的定量水平变化有利于指导治疗，若治疗后HBV DNA、HBeAg、HBsAg水平较基线快速下降能很好的预测疗程结束后的HBeAg血清学应答，且HBeAg水平变化较HBV DNA及HBsAg水平变化在预测普通IFN治疗HBeAg阳性CHB患者中能否获得血清学应答的敏感性和特异性更佳。
[Abstract]:Objective To observe the changes of ALT, HBV DNA, HBsAg and HBeAg titers in peripheral blood of patients with chronic hepatitis B (CHB) after receiving regular interferon (IFN) treatment, and to explore their relationship with HBeAg serological response after treatment.
Methods to treat 115 cases of interferon HBeAg positive CHB patients after informed consent were followed for 48 weeks, respectively in antiviral therapy at baseline (0 weeks), 12 weeks, 24 weeks, the serum were collected at 48 weeks, quantitative detection of HBsAg, HBeAg, HBV, DNA, ALT and the analysis of different levels. During the period of treatment at baseline level and related indicators (after 12 weeks, 24 weeks) of peripheral blood ALT, HBV, DNA, HBsAg, the relationship between the occurrence of HBeAg serological response HBeAg titer changes and IFN treatment of HBeAg positive CHB patients.
Results 48 weeks after antiviral therapy, 115 patients received interferon treatment initially, of which 14 cases were lost, or for the treatment of nucleoside analogues (joint) treatment in 18 cases, the clinical data of 4 cases of incomplete, failed to complete the basic course of 48 weeks. A total of 7 cases of residual IFN treatment completed 48 weeks of 72 cases among them, 28 patients underwent HBeAg seroconversion, 44 cases of patients with HBeAg remained positive. The baseline in patients received HBeAg seroconversion and without seroconversion (0 weeks) in different levels of ALT and HBeAg was statistically significant.IFN for 12 weeks, HBV DNA, HBeAg for 24 weeks, the level of HBsAg titer 6.511g 3.831g copies/ml are less than copies/ml, 2.38lg, S/CO, 0.87lg, S/CO, 4.33IU/ml, 4.07IU/ml after the end of treatment HBeAg seroconversion rate in high.12 weeks and HBV DNA were lower than 27% at baseline, 12 weeks, 24 weeks at the HBeAg level drop rate of more than 71%, 95% and HBsAg The decrease of the baseline was more than 65%, and the HBeAg serological conversion rate was well predicted at the end of the treatment at the end of the treatment.
Conclusion HBeAg positive CHB patients according to the baseline ALT in an ordinary IFN treatment, the forecast after 48 weeks of treatment, HBeAg seroconversion rate of HBeAg level, the dynamic observation of HBV DNA, and HBeAg after treatment, the changes of quantitative level of HBsAg is helpful to guide treatment, if HBV after treatment of DNA, HBeAg, HBsAg compared to the baseline level fast HBeAg can decrease the serologic response very well after the end of the forecast period, and the changes of HBeAg levels than HBV DNA and HBsAg IFN levels in the prediction of common treatment of HBeAg positive CHB patients can obtain serological response sensitivity and specificity was better.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.62

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