α-干扰素治疗慢性乙型肝炎儿童疗效及其影响疗效的因素分析

doi:10.3969/j.issn.1672-5069.2019.03.009

摘要/Abstract

摘要： 目的观察应用α干扰素（IFN-α）治疗慢性乙型肝炎（CHB）儿童的疗效,并分析影响疗效的因素。方法 2013年3月~2016年3月我科诊治的CHB患儿70例,随机分为两组,40例患儿接受α-干扰素治疗6个月,另30例患儿接受胸腺肽注射液治疗6个月。在治疗结束时,比较两组患儿血清丙氨酸氨基转移酶（ALT）复常率、HBsAg、HBeAg和HBV DNA转阴率,并分析影响CHB患儿治疗应答的因素。结果在治疗结束时,α-干扰素治疗患儿血清ALT复常率为97.5%,与胸腺肽治疗患儿的93.3%比,无显著性相差（P>0.05）,而血清HBeAg转阴率为40.0%,血清HBV DNA转阴率为77.5%,均显著高于胸腺肽治疗组患儿的10.0%和3.3%（x²=7.802,x²=37.998,P<0.05）;对α-干扰素治疗患儿的治疗应答进一步分析显示,30例血清ALT水平大于200 u/l者血清HBeAg转阴率和HBV DNA转阴率分别为46.7%和43.3%,显著高于10例血清ALT水平<200 U/L患者的10.0%和10. 0%（P<0.05）;32例年龄>5岁患儿血清HBeAg转阴率和HBV DNA转阴率分别为53.1%和50.0%,显著高于8例年龄<5岁患儿的12.5%和12.5%（P<0.05）;31例血清HBV DNA水平<6 lg copies/ml者血清HBeAg转阴率和HBV DNA转阴率分别为54.8%和61.3%,显著高于9例血清HBV DNA水平>6 lg copies/ml患儿的11.1%和22.2%（P<0.05）,而21例男性患儿血清HBeAg转阴率和HBV DNA转阴率分别为33.3%和28.6%,与19例女性患儿的47.4%和47.4%比,无显著性差异（P>0.05）,5例病程<1年患儿血清HBeAg转阴率和HBV DNA转阴率分别为80.0%和60.0%,与35例病程>1年患儿的45.7%和48.5%比,也无显著性差异（P>0.05）。结论应用IFN-α治疗CHB儿童有一定的近期疗效,但存在明显的不良反应,其疗效与患儿年龄、血清ALT和HBV DNA水平有关,值得进一步探讨。

关键词: 慢性乙型肝炎, α, -干扰素, 疗效, 预测因素, 儿童

Abstract: Objectiv To investigate the predictive factors of response to interferon-α（IFN-α） antiviral therapy in children with chronic hepatitis B （CHB）. Methods 70 children with CHB were recruited in our hospital between March 2013 and March 2016,and were randomly divided into IFN-α-treated （n=40） and thymopeptide-treated group （n=30）. All patients were treated for six months. Serum alanine aminotransferase （ALT） normalization rates,the negative rates of serum HBeAg and the negative rates of serum hepatitis B virus deoxyribonucleic acid（HBV DNA） were compared between the two groups. Results At the end of the regimen,serum ALT normalization rate in IFN-α-treated group was 97.5%,not significantly different compared to 93.3% in thymopeptide-treated group （P>0.05）,while serum HBeAg negativity rate was 40.0% and serum HBV DNA loss was 77.5%,both much higher than 10.0% and 3.3% （x²=7.802,x²=37.998,P<0.05） in thymopeptide-treated group;our further analysis about the response of IFN-αshowed that serum HBeAg and HBV DNA negativity rates in 30 children with serum ALT levels greater than 200 u/l were 46.7% and 43.3%,significantly higher than 10.0% and 10.0% （P<0.05） in 10 children with serum ALT levels less than <200 U/L;serum HBeAg and HBV DNA negativity rates in 32 children older than 5 years were 53.1% and 50.0%,significantly higher than 12.5% and 12.5%,respectively（P<0.05） in 8 children younger than 5 years;serum HBeAg and HBV DNA negativity rates in 31 children with serum HBV DNA levels greater than <6 lg copies/ml were 54.8% and 61.3%,significantly higher than 11.1% and 22.2%,respectively（P<0.05） in 9 children with serum HBV DNA levels greater than 6 lg copies/ml,while serum HBeAg and HBV DNA negativity rates in 21 boy were 33.3% and 28.6%,not significantly different compared to 47.4% and 47.4%,respectively（P>0.05） in 19 girls,and serum HBeAg and HBV DNA negativity rates in 5 children with less than one year illness period were 80.0% and 60.0%,not significantly different compared to 45.7% and 48.5%,respectively （P>0.05） in 35 children with disease period longer than one year. Conclusion IFN-α is in short-term effective for the treatment of children with CHB, but the incidence of adverse reactions are common,which warrants further investigation.

Key words: Chronic hepatitis B, Interferon α, Response, Predictive factors, Children

王宝丹, 李萌, 高于. α-干扰素治疗慢性乙型肝炎儿童疗效及其影响疗效的因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 345-348.

Wang Baodan, Li Meng, Gao Yu. Predictive factors of response to interferon-α antiviral therapy in children with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 345-348.

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