恩替卡韦序贯联合聚乙二醇干扰素α-2b治疗低水平HBsAg阳性CHB患者疗效观察

Curative effect of entecavir sequential therapy combined with peginterferonα-2b on patients with low-level HBsAg and CHB

目的:探讨恩替卡韦序贯联合聚乙二醇干扰素α-2b(Peg-IFN-α)治疗低水平乙型肝炎表面抗原(HBsAg)阳性慢性乙型肝炎(CHB)患者疗效。方法:选取2019年1月至2021年6月南通大学附属南通第三医院收治的120例HBsAg≤1500 IU/ml的CHB患者,通过随机数表发法分为恩替卡韦组(恩替卡韦治疗)、序贯组(序贯联合Peg-IFN-α治疗)和Peg-IFN-α组(Peg-IFN-α治疗)各40例,均持续治疗48周。比较3组患者治疗前后血清HBsAg水平、HBV DNA载量、HBsAg阴转率;Pearson相关性分析3组患者治疗前后血清HBsAg水平与HBV DNA载量的关系;比较3组患者治疗前后血清丙氨酸转移酶(ALT)、谷草转氨酶(AST)水平及治疗期间不良事件发生率。结果:序贯组、恩替卡韦组和Peg-IFN-α组各脱落2例、1例和4例,分别有38例、39例和36例患者完成48周疗程,3组间失访率差异无统计学意义(P>0.05);治疗12周和48周,序贯组血清HBsAg水平、HBV DNA载量低于恩替卡韦组和Peg-IFN-α组,血清HBsAg阴转率均高于恩替卡韦组和Peg-IFN-α组(P<0.05);Pearson相关性分析,治疗48周,序贯组、恩替卡韦组和Peg-IFN-α组的血清HBsAg水平与HBV DNA载量均呈显著正相关(P<0.05);治疗12周和48周,序贯组ALT、AST水平低于恩替卡韦组和Peg-IFN-α组(P<0.05);序贯组总不良事件发生率(47.37%)与恩替卡韦组(28.21%)和Peg-IFN-α组(27.77%)均无显著差异(P>0.05)。结论:恩替卡韦序贯Peg-IFN-α治疗可提高低水平HBsAg阳性CHB患者血清HBsAg阴转率,降低血清HBsAg和肝功能指标水平。

Objective:To explore the curative effect of entecavir sequential therapy combined with peginterferonα-2b(Peg-IFN-α)on patients with low-level hepatitis B surface antigen(HBsAg)and chronic hepatitis B(CHB).Methods:A total of 120 patients with HBsAg≤1500 IU/ml and CHB who were admitted to the hospital were enrolled between January 2019 and June 2021.According to the random number table method,they were divided into the entecavir group(entecavir),sequential group(entecavir sequential therapy combined with Peg-IFN-α),and Peg-IFN-αgroup(Peg-IFN-α),with 40 cases in each group.All were treated for 48 weeks.The level and negative conversion rate of HBsAg,and HBV DNA load were compared among the three groups before and after treatment.The relationship between the level of serum HBsAg and HBV DNA load was analyzed by Pearson correlation analysis.The levels of serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)before and after treatment and the incidence of adverse events during treatment were compared among the three groups.Results:There were two cases,one case,and four cases loss to follow-up in a sequential group,entecavir group and Peg-IFN-αgroup,and there were 38 cases,39 cases,and 36 cases completing the 48 weeks of treatment in the three groups,respectively.There was no significant difference in lost follow-up rate among the three groups(P>0.05).After 12 weeks and 48 weeks of treatment,the level of serum HBsAg and HBV DNA load in the sequential group were lower than those in the entecavir group and Peg-IFN-αgroup,while the negative conversion rate of serum HBsAg was higher than that in entecavir group and Peg-IFN-αgroup(P<0.05).Pearson correlation analysis showed that after 48 weeks of treatment,the level of serum HBsAg was significantly positively correlated with HBV DNA load in the three groups(P<0.05).After 12 weeks and 48 weeks of treatment,levels of ALT and AST in the sequential group were lower than those in the entecavir group and Peg-IFN-αgroup(P<0.05).The difference in the total incidence of adverse events in the sequential group(47.37%)was not statistically significant compared with that in the entecavir group(28.21%)and Peg-IFN-αgroup(27.77%,P>0.05).Conclusion:Entecavir sequential therapy combined with Peg-IFN-αcan increase the negative conversion rate of serum HBsAg,reduce levels of serum HBsAg and liver function indexes in patients with low-level HBsAg and CHB.