聚乙二醇干扰素α-2b联合核苷(酸)类似物治疗慢性乙型肝炎患者血清HBsAg清除率及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2026.05.007

摘要/Abstract

摘要： 目的探讨聚乙二醇干扰素α-2b(Peg-IFNα-2b)联合核苷(酸)类似物(NAs)治疗慢性乙型肝炎(CHB)患者实现血清HBsAg清除的相关影响因素。方法 2018年1月～2024年8月我院门诊诊治的246例CHB患者,其中未接受过任何抗病毒药物治疗的初治患者119例,服用过NAs治疗1年以上的经治患者127例,均接受Peg-IFNα-2b联合NAs治疗48周。采用二元Logistic回归分析影响HBsAg清除的因素,绘制受试者工作特征曲线(ROC),以曲线下面积(AUC)评估指标的预测效能。结果在治疗48周末,本组CHB患者实现血清HBsAg清除55例(22.4%);其中经治患者血清HBsAg清除率为30.7%,显著高于初治患者的13.4%(P＜0.05);HBsAg清除组基线血清HBsAg水平和HBV DNA载量分别为(2.6±0.6)lg IU/mL和(2.1±1.0)lg IU/mL,均显著低于HBsAg未清除组【分别为(3.3±0.7)lg IU/mL和(2.7±1.4)lg IU/mL,P＜0.05】;在治疗24周时,HBsAg清除组血清HBsAg水平下降(＞1 lg IU/mL)发生率为81.8%,显著高于HBsAg未清除组的17.8%(P＜0.05);多因素分析显示,基线低HBsAg水平、治疗24周HBsAg较基线下降和NAs经治均为实现HBsAg清除的独立影响因素(P均＜0.05);ROC分析显示,以基线HBsAg＜537.77 IU/mL为截断点预测HBsAg清除的AUC为0.748,其敏感度为73.3%,特异度为78.2%。结论选择长期接受NAs治疗获得血清HBsAg水平降得比较低的CHB患者,再联合应用Peg-IFNα-2b抗病毒治疗,实现功能性治愈的机会远远大于初治的血清HBsAg水平高的CHB患者。

关键词: 慢性乙型肝炎, 核苷(酸)类似物, 经治, 聚乙二醇干扰素α-2b, HBsAg清除, 功能治愈

Abstract: Objective This study was aimed to investigate serum HBsAg clearance and its influencing factors in patients with chronic hepatitis B (CHB) undergoing pegylated interferon α-2b (Peg-IFNα-2b) and nucleos(t)ide analogue (NAs) combination treatment. Methods A total of 246 patients with CHB, including naÏve in 119 cases and previously NAs-treated in 127 cases, were enrolled in our hospital between January 2018 and August 2024, and all received Peg-IFNα-2b in combination with NAs therapy for 48 weeks. Binary Logistic regression analysis was applied to identify factors impacting serum HBsAg clearance, and receiver operating characteristic curve (ROC) with the area under the curve (AUC) was drawn to evaluate predicting efficacy. Results By end of 48 week treatment, serum HBsAg clearance was obtained in 55 cases (22.4%) in our series; serum HBsAg clearance rate in NAs-treated patients was 70.9%,much higher than 29.1%(P＜0.05) in naive patients; baseline serum HBsAg level and HBV DNA load in HBsAg clearance group were (2.6±0.6)lg IU/mL and (2.1±1.0)lg IU/mL,both much lower than[(3.3±0.7)lg IU/mL and (2.7±1.4)lg IU/mL,respectively, P＜0.05] in those without HBsAg clearance; by end of 24 week antiviral treatment, incidence of decreased serum HBsAg level(＞1 lg IU/mL)in those with HBsAg clearance was 81.8%,much higher than 17.8%(P＜0.05)in those without serum HBsAg clearance; multivariate Logistic regression analysis showed that baseline serum HBsAg level, decreased serum HBsAg at 24 week antiviral treatment and NAs-treated were all the independent impacting factors for serum HBsAg clearance (P＜0.05);ROC analysis demonstrated that the AUC was 0.748,with sensitivity of 73.3% and specificity of 78.2%, when baseline serum HBsAg＜537.77 IU/mL was set as the cut-off-value in predicting serum HBsAg clearance. Conclusion The optimal alleged patients with CHB might be those with low serum HBsAg levels and low serum HBV DNA loads with long-term NAs treatment for Peg-IFNα-2b and NAs combination antiviral treatment, who will obtain functional cure.

Key words: Hepatitis B, Pegylated interferon α-2b, Nucleos(t)ide analogues, HBsAg clearance, Functional cure

祁雁, 杜合娟, 张晨霞, 史帝文, 邱源旺. 聚乙二醇干扰素α-2b联合核苷(酸)类似物治疗慢性乙型肝炎患者血清HBsAg清除率及其影响因素分析^*[J]. 实用肝脏病杂志, 2026, 29(5): 665-668.

Qi Yan, Du Hejuan, Zhang Chenxia, et al. Serum HBsAg clearance and its influencing factors in patients with chronic hepatitis B receiving pegylated interferon α-2b and nucleos(t)ide analogue combination treatment[J]. Journal of Practical Hepatology, 2026, 29(5): 665-668.

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聚乙二醇干扰素α-2b联合核苷(酸)类似物治疗慢性乙型肝炎患者血清HBsAg清除率及其影响因素分析^*

Serum HBsAg clearance and its influencing factors in patients with chronic hepatitis B receiving pegylated interferon α-2b and nucleos(t)ide analogue combination treatment

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