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*

doi:10.3969/j.issn.1672-5069.2019.04.010

摘要/Abstract

摘要： 目的探讨应用α-干扰素治疗的慢性乙型肝炎（CHB）患者血清干扰素-γ诱导蛋白-10（IP-10）、I型干扰素受体（IFNAR）和辅助性T细胞17（Th-17）水平变化及其对治疗应答的影响。方法 2015年6月~2017年12月我科收治的105例CHB患者,采用聚乙二醇化干扰素α-2b治疗48周。采用RT-PCR法检测血清HBV DNA载量,采用双抗体夹心法检测血清干扰素-γ诱导蛋白-10（IP-10）,采用RT-PCR法测定外周血单个核细胞α/β干扰素受体（IFNAR-α、IFNAR-β）、辅助性T细胞17（IL-17A）和IL-17F。采用多因素Logistic回归分析影响聚乙二醇化干扰素α-2b治疗CHB患者应答的影响因素。结果在治疗结束时,在105例CHB患者中获得完全应答56例（53.3%）,未获得完全应答49例;单因素分析显示获得完全应答与未获得完全应答患者血小板、白蛋白、总胆红素、凝血酶原时间、IFNAR-α和IFNAR-β差异无统计学意义（P>0.05）,应答组基线白细胞计数、血清丙氨酸氨基转移酶、HBV DNA、HBsAg、IP-10、IL-17A和、IL-17F水平分别为（5.6±1.7）×10⁹/L、（108.6±9.5） U/L、（5.4±0.8） lg copies/ml、（4.6±0.9） lg IU/ml、（324.5±86.9） pg/ml、（3.2±0.6）平均荧光强度（MFI）、（3.1±0.5） MFI,与未应答组的（6.4±1.9）×10⁹/L、（82.5±10.0）U/L、（6.1±0.9） lg copies/ml、（5.8±1.1） lgIU/ml、（381.4±79.6） pg/ml、（3.8±0.7） MFI、（3.6±0.7） MFI比,差异显著（P<0.05）;多因素Logistic回归分析显示,血清HBV DNA、HBsAg、IP-10、IL-17A和IL-17F水平是影响α-干扰素治疗CHB患者应答的因素（P<0.05）。结论除常识性认识到的血清HBV DNA和HBsAg水平外,本研究发现检测血清IP-10和Th-17水平有助于对CHB患者在α-干扰素治疗后应答反应的预测,或许能为临床做出治疗决定有裨益。

关键词: 慢性乙型肝炎, α-干扰素, 干扰素-γ诱导蛋白-10, I型干扰素受体, 辅助性T细胞17, 疗效预测

Abstract: Objective To investigate the efficacy of peginterferon alfa-2b treatment and affecting response factors in patients with chronic hepatitis B （CHB）.Methods A total of 105 patients with CHB were recruited in our hospital between June 2015 and December 2017,and all patients were treated by peginterferon alfa-2b for 48 weeks. Serum HBV DNA,HBeAg and HBsAg,as well as interferon-γ-induced protein-10（IP-10）,interferon-α/β receptor （IFNAR）,and T helper cell 17 （Th-17） were detected. Multivariate Logistic regression analysis was applied to demonstrate the prognostic factors of response to peginterferon alfa-2b therapy in patients with CHB.Results At the end of treatment regimen,56 patients（53.3%）,while 49 failed to respond to peginterferon alfa-2b therapy;there were no significant differences as respect to blood platelet counts,serum albumin,total bilirubin,prothrombin time,IFNAR-α and IFNAR-β between responders and non-responders（P>0.05）,while the baseline white blood cell counts,serum alanine aminotransferase,HBV DNA loads,HBsAg,IP-10,IL-17A and IL-17F in the responded group were（5.6±1.7）×10⁹/L,（108.6±9.5） U/L,（5.4±0.8） lg copies/ml,（4.6±0.9） lg IU/ml,（324.5±86.9） pg/ml,（3.2±0.6） mean fluorescene intendity （MFI） and（3.1±0.5） MFI in responders,significantly different as compared to（6.4±1.9）×10⁹/L,（82.5±10.0） U/L,（6.1±0.9） lgcopies/ml,（5.8±1.1） lg IU/ml,（381.4±79.6） pg/ml,（3.8±0.7） MFI and （3.6±0.7） MFI in the non-responder group （P<0.05）;multivariate Logistic regression analysis showed that serum HBV DNA loads,HBsAg,IP-10,IL-17A and IL-17F were the prognostic factors of response in patients with CHB treated with α-interferon （P<0.05）. Conclusion Serum HBV DNA,HBsAg,IP-10 and Th-17 are the prognostic factors affecting the response in patients with CHB after treatment of α-interferon,and detection of serum IP-10 and Th-17 might help predict the efficacy of peginterferon alfa-2b treatment.

Key words: Chronic hepatitis B, IFN-γ inducible protein 10, Interferon-α/β receptor, Th-17, Response, Prediction

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^*[J]. 实用肝脏病杂志, 2019, 22(4): 490-493.

Bai Yichun, Deng Jihong, Mei Xiaoping. Efficacy of peginterferon alfa-2b treatment and affecting response factors in patients with chronic hepatitis B[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(4): 490-493.

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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^*

Efficacy of peginterferon alfa-2b treatment and affecting response factors in patients with chronic hepatitis B

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