PEG-IFNα-2a与PEG-IFNα-2b治疗慢性乙型肝炎患者疗效研究

doi:10.3969/j.issn.1672-5069.2021.01.008

摘要/Abstract

摘要： 目的分析比较应用聚乙二醇干扰素α-2a(PEG-IFNα-2a)与聚乙二醇干扰素α-2b(PEG-IFNα-2b)治疗慢性乙型肝炎(CHB)患者的疗效。方法 2016年7月～2018年5月我院收治的CHB患者74例,采用随机数字表法分为A组和B组,各37例,分别给予PEG-IFNα-2a或PEG-IFNα-2b治疗48 w,随访24 w。结果在治疗12 w、24 w、48 w和随访24 w末,A组ALT复常率分别为29.7%、35.1%、83.8%和75.7%,与B组(27.0%、29.7%、86.5%和78.4%)比,差异无统计学意义(P>0.05);血清HBV DNA转阴率分别为59.5%、73.0%、78.4%和75.7%,与B组(45.9%、51.4%、81.1%和75.7%)比,差异无统计学差异(P>0.05);血清HBeAg转阴率分别为33.3%、36.7%、36.7%和40.5%,与B组(29.2%、29.2%、33.3%和35.1%)比,差异无统计学差异(P>0.05);在治疗过程中,两组流感样症状比较常见,A组外周血血小板和粒细胞减少发生率分别为40.0%和76.6%,与B组的37.8%和75.7%比,差异无统计学意义(P>0.05)。结论在现阶段,选择应用PEG-IFNα-2a或PEG-IFNα-2b治疗CHB患者均能获得比较好的临床疗效,但需监测不良反应,及时处理血细胞下降,以维持治疗,完成疗程。

关键词: 慢性乙型肝炎, 聚乙二醇干扰素α-2a, 聚乙二醇干扰素α-2b, 治疗

Abstract: Objective The aim of this study was to compare the antiviral response to pegylated interferon-α (PEG-IFNα-2a) or PEG-IFNα-2b in patients with chronic hepatitis B (CHB). Methods 74 patients with CHB were enrolled in our hospital between July 2016 and May 2018, and were randomly divided into group A (n=37) and group B (n=37). The patients in group A were treated with PEG-IFNα-2a, and those in group B were treated with PEG-IFNα-2b. The antiviral therapy lasted for 48 w, and all patients were followed-up for 24 weeks. Results At the end of 12 w, 24 w and 48 w treatment and 24 w followed-up, serum alanine aminotransaminase (ALT) normalization rates in goup A were 29.7%, 35.1%, 83.8% and 75.7%, all not significantly different as compared to 27.0%, 29.7%, 86.5% and 78.4%, respectively, (P>0.05) in group B; serum HBV DNA loss were 59.5%, 73.0%, 78.4% and 75.7%, all not significantly different as compared to 45.9%, 51.4%, 81.1% and 75.7%, respectively, (P>0.05) in group B; serum HBeAg negative rates were 33.3%, 36.7%, 36.7% and 40.5%, all not significantly different as compared to 29.2%, 29.2%, 33.3% and 35.1%, respectively, (P>0.05) in group B; during the treatment, the incidences of flu-like symptoms and abnormal thyroid functions in the two groups were the same, and the incidences of thrombocytopenia and granulocytopenia in group A were 40.0% and 76.6%, both notsignificantly different as compared to 37.8% and 75.7% in group B (P>0.05).Conclusion At present, both PEG-IFNα-2a and PEG-IFNα-2b could be selected for the treatment of patients with CHB, and the surveillance of untoward effects is pivotally important for the regimen going and the achievement of antiviral therapy.

Key words: Hepatitis B, Pegylated interferon-α2a, Pegylated interferon-α2b, Therapy

林金祥, 杨可立. PEG-IFNα-2a与PEG-IFNα-2b治疗慢性乙型肝炎患者疗效研究[J]. 实用肝脏病杂志, 2021, 24(1): 27-30.

Lin Jinxiang, Yang Keli. Comparison of response toPEG-IFNα-2a or PEG-IFNα-2b in patients with chronic hepatitis B[J]. Journal of Practical Hepatology, 2021, 24(1): 27-30.

参考文献

[1] Stelma F, Van DH, Jansen L, et al. HBsAg loss after peginterferon and nucleotide combination treatment in chronic hepatitis B patients: 5 years of follow-up. J Viral Hepat, 2017, 24(12): 1107-1113.
[2] Czerwionkaszaflarska M, Chrobot A, Szaflarskaszczepanik A. Studies of the effectiveness of interferon alpha treatment for chronic hepatitis c in children. Med Sci Monit, 2016, 6(5): 964-970.
[3] 王丽旻, 张鸿飞, 董漪, 等.α-干扰素治疗慢性乙型肝炎儿童对身高及体质量的影响. 中华传染病杂志, 2017, 35(1): 11-14.
[4] 王贵强, 王福生, 成军, 等. 慢性乙型肝炎防治指南(2015年版). 实用肝脏病杂志, 2016, 19(3): 389-400.
[5] Jorgensen C, Chen S, Carnes CA, et al. Know hepatitis B: amultilingual communications campaign promoting testing for hepatitis B among Asian Americans and pacific islanders. Public Health Rep, 2016, 131(Suppl 2): 35-40.
[6] Boglione L, Cariti G, Ghisetti V, et al. Extended duration of treatment with peginterferon alfa-2a in patients with chronic hepatitis B, HBeAg negative and e genotype: a retrospective analysis. J Med Virol, 2018, 90(6): 1047-1052.
[7] Hsu CW, Su WW, Lee CM, et al. Phase iv randomized clinical study: peginterferon alfa-2a with adefovir or entecavir pretherapy for hbeagpositive chronic hepatitis B. J Formos Med Assoc, 2018, 117(7): 588-597.
[8] Rizzo MD, Crawford RB, Henriquez JE, et al. HIV infected cannabis users have lower circulating cd16⁺ monocytes and IFN-γ-inducible protein 10 levels compared with nonusinghiv patients. Aids, 2018, 32(4): 419-429.
[9] Ding Y, Lou J, Hong C, et al. Tolerability, pharmacokinetics and antiviral activity of rhsa/ifnα2a for the treatment of chronichepatitis B infection. Br J Clin Pharmacol, 2017, 83(5): 1056-1071.
[10] Ting L, Guang X, Yuan X. Effect of switching from treatment with nucleos(t)ide analogs to pegylated interferonα-2a on virological and serological responses in chronic hepatitis b patients. World J Gastroenterol, 2016, 22(46): 10210-10218.
[11] 李卫, 李丽军, 李永华, 等. 回顾性分析聚乙二醇干扰素治疗HBeAg阳性慢性乙型肝炎患者抗病毒方案调整分析. 中华医院感染学杂志, 2017, 27(14): 3192-3195.
[12] Huang Y, Li M H, Hou M, et al. Peginterferon alfa-2a for the treatment of chronic hepatitis C in the era of direct acting antivirals. Hepatobiliary Pancreat Dis Int, 2017, 16(5): 470-479.
[13] Marcellin P, Sang H A, Ma X, et al. Combination of tenofovir disoproxil fumarate and peginterferon alfa-2a increases loss of hepatitis B surface antigen in patients with chronic hepatitis B. Gastroenterology, 2016, 150(1): 134-144.
[14] Chan LY, Messinger D, Papatheodoridis GV, et al. A genotypespecific baseline score to predict posttreatment response to peginterferon alfa-2a in HBeAg positive patients with hepatitis B virus genotype b or c infection. J Hepatol, 2016, 64(2): S589-S590.
[15] Lampertico P, Messinger D, Cornberg M, et al. Agenotype E specific baseline score to predict response at 48 weeks posttreatment to peginterferon alfa-2a in patients with HBeAg negative chronic hepatitis B. J Hepatol, 2016, 64(2): S599-S600.
[16] Gschwantler M, Laferl H, Vogel W, et al. Efficacy of peginterferon plus ribavirin in patients receiving opioid substitution therapy: final results of the Austrian peghope study.Wien Klin Wochenschr, 2017, 53(5): 1-8.
[17] Hundie GB, Raj VS, Gebre MD, et al. Molecular epidemiology and genetic diversity of hepatitis B virus in Ethiopia. J MedVirol, 2016, 88(6): 1035-1043.
[18] 涂杰霞, 王安娜, 廖若汐. 干扰素α-2b与聚乙二醇干扰素α-2a治疗慢性乙型肝炎患者疗效比较研究. 实用肝脏病杂志, 2019, 22(5): 648-651.
[19] Martinot P M, Lapalus M, Maylin S, et al. Baseline HBsAg and HBcAg titres allow peginterferon-based 'precision medicine' in HBeAg negative chronic hepatitis B patients. J Hepatol, 2016, 23(11): 905-911.
[20] 袁春晖, 李春雨, 李红丽, 等. 国产聚乙二醇化干扰素α治疗HBeAg阳性慢性乙型肝炎患者疗效研究. 实用肝脏病杂志, 2019, 22(3): 353-356.
[21] Jindal A, Vyas A K, Kumar D, et al. Higher efficacy of pegylated interferon-α2b add on therapy in hepatitis B envelope antigenpositive chronic hepatitis B patients on tenofovir monotherapy. J Hepatol, 2018, 4(7): 24-26.
[22] 白一春, 邓霁红, 梅小平. 影响聚乙二醇干扰素α-2b治疗慢性乙型肝炎患者疗效的多因素分析. 实用肝脏病杂志, 2019, 22(4): 490-493.
[23] Wong D, Walsh R, Hammond R, et al. Thu-163-on-treatment alt flares are associated with HBsAg loss in genotype a chronic hepatitis B infected patients treated with nucleotide analogue therapy. J Hepatol, 2017, 66(1):260.