α-干扰素治疗慢性乙型肝炎完全应答后5年随访报告

doi:10.3969/j.issn.1672-5069.2014.04.012

摘要/Abstract

摘要： 目的观察重组α-干扰素（rIFN-α）治疗慢性乙型肝炎（CHB）取得完全应答后随访5年的复发情况及其影响因素。方法对经rIFN-α治疗取得完全应答的186例CHB患者,在治疗结束后,每3个月复查1次,随访1年,以后每半年复查1次,一旦复发,则根据情况1~3个月复查1次。随访5年,观察病例复发率,并对影响复发的可能因素进行分析。结果在186例患者中,持续应答119例（64.0%）,复发67例（36.0%）,复发最早发生在停药后2个月, 最晚发生在停药后47个月,第1年内复发43例（23.1%）,第5年内无复发病例,随着随访时间延长,复发率逐年降低,而累计复发率逐年增高,各年复发率和累计复发率差异均有显著性（P<0.05或P<0.01）,第2、3、4年复发率分别为9.1%、6.2%和2.5%,差异无统计学意义（P>0.05）;年龄<40岁组复发率为31.1%,明显低于年龄≥40岁组的48.2%（P<0.05）;IFN-α疗程≥6 m组复发率为52.5%,明显高于疗程≥12 m组的34.4%（P<0.05）和疗程≥18 m组的26.0%（P<0.01）;治疗前HBV DNA≤1×10⁶ copies/ml组复发率为26.5%,明显低于HBV DNA>1×10⁶ copies/ml组的41.5%（P<0.05）;性别、IFN-α剂量和治疗前ALT水平与复发无明显相关（P>0.05）。结论rIFN-α治疗后完全应答的CHB患者第1年内复发率较高,患者年龄、疗程及治疗前HBV DNA水平是复发的影响因素,而性别、IFN-α剂量和治疗前ALT水平对复发无明显影响。

关键词: 慢性乙型肝炎, α, -干扰素, 联合应答, 复发, 影响因素

Abstract: Objective To investigate the relapse and its influencing factors in patients with chronic hepatitis B （CHB） after recombinant interferon-alpha （rIFN-α） treatment during 5 years of followed-up. Methods 186 CHB patients with complete response after rIFN-α treatment were followed-up for 5 years,and the relapse rate was observed and the possible factors influencing relapse were analyzed. Results Out of 186 patients,sustained virologic response was obtained in 119 cases （64.0%）,and the relapse occurred in 67 cases （36.0%）;Recurrence of illness occurred from the first 2 months to 47 months after stopping antiviral treatment,and 43 cases（23.1%） got relapse in the first year,while no relapse case in the fifth year;With the followed-up period prolonged,the recurrence rate reduced year by year,and the cumulative recurrence rate increased year by year. The recurrence rates of second, third and fourth year were 9.1%,6.2% and 2.5%,respectively,without statistically significant difference among them（P>0.05）. The relapse rate of patients younger than 40 years was 31.1%,much lower than 48.2% in patients older than 40 years（P<0.05）. The relapse rate in patients receiving IFN-α of 6 month course was 52.5%,much higher than 34.4% in receiving IFN-α of one year course（P<0.05） or 26.0% in receiving IFN-α of 18 month course（P<0.01）. The relapse rates in patients with underlying HBV DNA≤1×10⁶copies/ml was 26.5%,much lower than 41.5% in with HBV DNA>1×10⁶ copies/ml （P<0.05）. The relapse was not related to patient's gender,IFN-α doses and pretreatment serum ALT level（P>0.05）. Conclusion The relapse rate of CHB patients with complete response after IFN-α treatment as higher in the first year after discontinuation of the regimen,and the patient's age,treatment course and pretreatment HBV DNA levels are the influencing factors of relapse,but not the patient's gender,IFN-α doses and ALT level before treatment.

Key words: Chronic hepatitis B, Interferon-alpha, Complete response, Relapse, Influencing factor

占国清, 谭华炳, 李芳, 李儒贵, 李刚, 张薇薇, 郭鹏. α-干扰素治疗慢性乙型肝炎完全应答后5年随访报告[J]. 实用肝脏病杂志, 2014, 17(4): 380-384.

Zhan Guoqing, Tan Huabing, Li Fang. A five year followed-up study on chronic hepatitis B patients with complete response after interferon-α treatment[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(4): 380-384.

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