聚乙二醇干扰素联合抗病毒药物治疗慢性乙型肝炎病毒DNA转阴患者临床观察

Clinical observation of peginterferon combined with antiviral drugs in the treatment of patients with chronic hepatitis B virus DNA negative

目的口服核苷(酸)类似物抗病毒药物治疗慢性乙型肝炎需要长期治疗,本研究探讨聚乙二醇干扰素联合抗病毒药物在经治的慢性乙型肝炎病毒DNA转阴患者中的应用效果。方法选取2017-01-01-2018-01-01辽宁省人民医院感染科收治的68例应用恩替卡韦或替诺福韦抗病毒治疗并且已经出现乙肝病毒DNA转阴的慢性乙肝患者作为研究对象,分为观察组(34例)和对照组(34例)。对照组继续使用抗病毒药物恩替卡韦或替诺福韦治疗,观察组在对照组的治疗基础上加用180μg聚乙二醇干扰素α-2a治疗,比较两组乙肝表面抗原(HBsAg)阴转率及较基线下降值。结果观察组出现6例HBsAg转阴,对照组未出现HBsAg转阴,χ2=8.899,P=0.003。治疗前后观察组HBsAg定量差值为(3.15±0.47)IU/mL,高于对照组的(2.35±1.03)IU/mL,差异有统计学意义,t=4.086,P<0.001。治疗期间观察组出现发热25例,高于对照组的0例,差异有统计学意义,χ2=50.147,P<0.001;转氨酶升高14例,高于对照组的0例,差异有统计学意义,χ2=23.080,P<0.001;白细胞降低15例,高于对照组的0例,差异有统计学意义,χ2=25.098,P<0.001;白细胞和血小板均降低10例,高于对照组的0例,差异有统计学意义,χ2=15.596,P<0.001。结论经治的慢性乙肝患者在出现乙肝病毒DNA阴转后联合聚乙二醇干扰素治疗,可以提高HBsAg的清除率,降低HBsAg定量。

Objective Oral nucleoside(acid)analog antiviral drugs for chronic hepatitis B require long-term treatment.This study explored the application of peginterferon combined with antiviral drugs in treated patients with chronic hepatitis B virus DNA negative conversion.Methods A total of 68 patients with chronic hepatitis B who were treated with entecavir or tenofovir and who had been treated with hepatitis B virus DNA,who were treated in Department of Infectious Diseases,Liaoning Provincial People’s Hospital from January 1,2017 to January 1,2018,were selected as the research objects and divided into observation group(34 cases)and the control group(34 cases).The control group continued to be treated with antiviral drugs entecavir or tenofovir,and the observation group was treated with 180μg peginterferonα-2 aon the basis of the treatment of the control group.The two groups were compared with hepatitis B surface antigen(HBsAg)negative conversion rate and decrease from baseline.Results There were 6 cases of HBsAg becoming negative in the observation group,and no HBsAg becoming negative in the control group,χ2=8.899,P=0.003.The quantitative difference of HBsAg in the observation group before and after treatment was(3.15±0.47)IU/ml,which was higher than that in the control group(2.35±1.03)IU/ml,the difference was statistically significant,t=4.086,P<0.001.During the treatment,25 patients in the observation group had fever,which was higher than that in the control group,with statistically significant difference(χ2=50.147,P<0.001).Transaminase was increased in 14 cases,higher than that in 0 cases in the control group,with statistically significant difference(χ2=23.080,P<0.001).Leukocyte numbers decreased in15 cases,higher than that in 0 cases in the control group,with statistically significant difference(χ2=25.098,P<0.001).White blood cell and platelet decreased in 10 cases,higher than that in 0 cases in the control group,the difference was statistically significant(χ2=15.596,P<0.001).Conclusion Treated patients with chronic hepatitis B combined with peginterferon treatment after hepatitis B virus DNA negative conversion can increase the clearance rate of HBsAg and reduce the quantification of HBsAg.