聚乙二醇干扰素α-2a治疗HBeAg阳性慢性乙型肝炎患者3年随访研究

doi:10.3969/j.issn.1672-5069.2023.05.006

摘要/Abstract

摘要： 目的分析应用聚乙二醇干扰素α-2a(peg-IFN α-2a)治疗血清HBeAg阳性的慢性乙型肝炎(CHB)患者随访3年的效果。方法 2017年3月～2018年3月我院收治的72例HBeAg阳性初治CHB患者,均给予peg-IFN α-2a治疗,其中A组33例治疗48周,B组39例治疗72周。随访3年。考察两组血清HBsAg消失、HBeAg消失、HBeAg血清转换、HBV DNA转阴和ALT复常率,使用FibroTouch肝脏瞬时弹性成像仪行肝脏硬度检测(LSM)。结果在治疗48周结束时,两组疗效无显著性差异(P>0.05);在治疗72周结束时,B组血清HBsAg消失、HBeAg消失、HBeAg血清转换、HBV DNA转阴和ALT复常率分别为33.3%、64.1%、71.8%、69.2%和74.4%,显著高于A组(分别为12.1%、39.4%、48.5%、45.5%和51.5%,P<0.05);在随访2年时,B组HBsAg消失、HBeAg消失、HBeAg血清转换、HBV DNA转阴和ALT复常率分别为43.6%、69.2%、74.4%、74.4%和79.5%,显著高于A组(分别为21.2%、42.4%、51.5%、48.5%和54.6%,P<0.05);在随访3年时,B组分别为46.2%、76.9%、82.1%、79.5%和84.6%,也显著高于A组(分别为27.3%、57.6%、60.7%、60.6%和72.7%,P<0.05);在治疗48周、72周、随访2年和3年时,B组LSM分别为(7.9±1.2)kPa、(7.0±0.9)kPa、(6.8±1.3)kPa和(6.4±1.8)kPa,而A组则分别为(7.9±1.0)kPa、【(7.5±0.8)kPa,P<0.05】、(7.0±1.2)kPa和(6.5±1.2)kPa;在随访结束时,本组CHB患者发生HBeAg血清学转换52例,未发生HBeAg血清学转换20例;应答与未应答组年龄、治疗疗程和基线HBeAg水平存在显著性差异(P<0.05);经多因素Logistics回归分析显示它们均是HBeAg血清转换的独立影响因素(P<0.05)。结论延长peg-IFN α-2a治疗疗程可提高CHB患者临床疗效,且安全性良好,还可能有助于消除肝纤维化。

关键词: 慢性乙型肝炎, 聚乙二醇干扰素α-2a, HBeAg阳性, 治疗, 长期疗效

Abstract: Objective The aim of this study was to investigate the 3-year follow-up results of patients with serum HBeAg-positive chronic hepatitis B (CHB) after 48 to 72 week pegylated interferon α-2a (peg-IFN α-2a) treatment. Methods 72 na-ve patients with serum HBeAg-positive CHB were recruited in our hospital between March 2017 and March 2018, and all received peg-IFN α-2a treatment, including 33 patients in group A treated for 48 weeks and 39 patients in group B for 72 weeks. All patients in our series were followed-up for three years. The clinical efficacy, as serum HBsAg disappearance rate, HBeAg disappearance rate, HBeAg seroconversion rate, HBV DNA negative conversion rate and ALT normalization rate were compared between the two groups. The liver stiffness measurement (LSM) was measured by FibroTouch liver transient elastography. The independent impacting factors for serum HBeAg seroconversion were analyzed by Logistics regression analysis. Results At the end of 48 week treatment, there was no significant difference respect to the antiviral efficacy between the two groups (P>0.05); at the end of 72 weeks, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 33.3%, 64.1%, 71.8%, 69.2% and 74.4%, much higher than 12.1%, 39.4%, 48.5%, 45.5% and 51.5% (P<0.05) in group A; at the end of two year follow-up, serum HBsAg disappearance, HBeAg disappearance, HBeAg seroconversion, HBV DNA loss and ALT normalization rates in group B were 43.6%, 69.2%, 74.4%, 74.4% and 79.5%, much higher than 21.2%, 42.4%, 51.5%, 48.5% and 54.6% (P<0.05) in group A and at the end of 3 year follow-up, they were 46.2%, 76.9%, 82.1%, 79.5% and 84.6% in group B, also much higher than 27.3%, 57.6%, 60.7%, 60.6% and 72.7% (P<0.05) in group A; at the end of 3 year follow-up, serum HBeAg seroconversion was obtained in 52 cases in our series, and there were significant differences as respect to the ages, antiviral regimen period and serum HBeAg levels at baseline between patients with and without serum HBeAg seroconversion (P<0.05); the multivariate Logistics analysis showed that the age, treatment course of peg-IFN α-2a and baseline HBeAg levels were the independent factors affecting HBeAg seroconversion (P<0.05). Conclusion The prolongation of antiviral course of peg-IFN α-2a might improve the clinical efficacy, and the regimen has a good safety and could enhance the anti-hepatic fibrosis ability.

Key words: Hepatitis B, Pegylated interferon α-2a, HBeAg positive, Therapy, Long-term efficacy

王一卓, 张崴琪, 李红. 聚乙二醇干扰素α-2a治疗HBeAg阳性慢性乙型肝炎患者3年随访研究[J]. 实用肝脏病杂志, 2023, 26(5): 626-629.

Wang Yizhuo, Zhang Weiqi, Li Hong. A 3-year follow-up of patients with serum HBeAg-positive chronic hepatitis B after 48 to 72 week pegylated interferon α-2a treatment[J]. Journal of Practical Hepatology, 2023, 26(5): 626-629.

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