HBeAg阳性慢性乙型肝炎患者干扰素治疗24周应答不佳时的治疗方案

发布时间：2018-08-07 19:29

【摘要】：目的对干扰素单药治疗24周应答不佳的HBe Ag阳性慢性乙型肝炎(CHB)患者采用不同的治疗方案进行后续治疗,分析比较其疗效和安全性。方法回顾性分析2010年9月~2013年1月南方医科大学南方医院193例干扰素治疗24周时应答不佳的HBe Ag阳性的CHB患者,根据不同后续治疗方案分成:联用恩替卡韦(ETV)或阿德福韦(ADV)治疗(A组),继续干扰素单药治疗(B组),换为NAs治疗(C组),直接停止治疗(D组)。观察比较第24、48、72周时各组患者的临床疗效与安全性。结果继续治疗至疗程48周时,A组和C组HBV DNA转阴率、ALT复常率均高于B组(A组:χ2=26.808,P0.001和χ2=5.485,P=0.017;C组:χ2=21.257,P0.001和χ2=5.369,P=0.018);同时发现,加ETV组HBV DNA转阴率高于加ADV组(χ2=8.255,P=0.004)。疗程72周时,A组患者有27例(39.7%)发生HBe Ag血清学转换,明显高于B、C两组(χ2=4.238,P=0.04和χ2=7.681,P=0.006);58例(85.3%)获得HBV DNA转阴,59例(86.8%)ALT恢复正常,均高于B组(χ2=23.018,P0.001和χ2=5.987,P=0.014),但与C组比较差异无统计学意义(P0.05);同时发现,联合ETV组HBV DNA转阴率和HBe Ag血清学转换率均高于加ADV组(χ2=9.823,P=0.002和χ2=5.450,P=0.020)。D组,28例患者的HBV DNA均持续较高水平复制,HBe Ag水平升高,ALT反复波动。结论对于干扰素单药治疗24周时应答不佳的CHB患者,联用NAs并延长疗程可明显提高HBe Ag血清学转换率、HBV DNA转阴率及ALT复常率,特别是联用ETV并延长疗程时。
[Abstract]:Objective to evaluate the efficacy and safety of interferon alone in the treatment of HBe Ag positive patients with chronic hepatitis B (CHB) in 24 weeks. Methods from September 2010 to January 2013, 193 patients with HBe Ag positive CHB who were treated with interferon at the Southern Hospital of Southern Medical University were analyzed retrospectively. The patients were divided into two groups according to the following treatment: group A treated with entecavir (ETV) or adefovir (ADV) (group A), group B treated with interferon alone (group B), treated with NAs (group C), and treated with direct cessation of treatment (group D). To observe and compare the clinical efficacy and safety of each group at week 24, 48 and 72. Results after 48 weeks of treatment, the negative conversion rate of HBV DNA in group A and group C was significantly higher than that in group B (group A: 蠂 2 + 26.808) P0.001 and group C (蠂 25.485): P 0.001 and 蠂 ~ (2 +) 5.369P0.018, and the negative conversion rate of HBV DNA in ETV group was higher than that in group B (蠂 ~ (2) 8.255P _ (0.004). HBe Ag seroconversion occurred in 27 patients (39.7%) in group A at 72 weeks of treatment, which was significantly higher than that in group C (蠂 2 + 4.238%, P 0.04 and 蠂 2 (7.681) P 0. 006). 59 cases (86.8%) of HBV DNA turned negative to normal, which were higher than those in group B (蠂 2 + 23.018 P 0.001 and 蠂 2 5.98 7 P 0. 014), but there was no significant difference between group C and group C (P0.05), and it was found that there was no significant difference between group C and group C (P 0.05), and the positive rate of ALT in group A was significantly higher than that in group B (P < 0.05), but there was no significant difference between group C and group C (P 0.05). The negative rate of HBV DNA and the serological conversion rate of HBe Ag in the combined ETV group were higher than those in the + ADV group (蠂 2 + 9. 823 P0. 002 and 蠂 2 + 5. 450 P + 0. 020). The HBV DNA levels of the 28 patients with ETV were significantly higher than those of the control group (蠂 2 + 9. 823 P0. 002 and 蠂 2 + 5. 450 P + 0. 020). Conclusion for patients with CHB who have a poor response at 24 weeks after treatment with interferon alone, the serological conversion rate of HBe Ag and the return rate of ALT in combination with NAs and prolongation of the course of treatment can be significantly increased, especially when combined with ETV and prolonging the course of treatment.
【作者单位】：南方医科大学南方医院感染内科//国家器官衰竭研究重点实验室//广东省病毒性肝炎研究重点实验室;
【基金】：国家自然科学基金(81470856) 中国肝炎防治基金会课题(XJS20120601)~~
【分类号】：R512.62

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