动态观察血清HBV-DNA水平预测干扰素治疗慢性乙型肝炎疗效的意义

Serum HBV-DNA level can predict treatment effectiveness in patients with chronic hepatitis B using interferon-α-_(2a)

目的 研究干扰素 α 2a治疗慢性乙型病毒性肝炎 (慢性乙肝 )期间 ,患者血清中HBV-DNA定量的动态变化与疗效的关系。方法 5.8例慢性乙肝患者皮下注射干扰素 α-2a3MIU 次 ,每周 3次 ,疗程 6个月。观察患者血清中HBV DNA定量和丙氨酸转氨酶 (ALT)的动态变化。结果 完全有效组治疗 1个月后 ,患者血清中HBV DNA定量显著降低 [(3 99± 0.91)log1.0 ],明显低于部分有效组[(5.6 3± 1.31)log1 0 ]和无效组 [(6.6 9± 1.4 2 )log1 0 ],(P <0.0 5 )。疗效不同的 3组患者经过 1个月的治疗 ,血清中HBV DNA定量分别下降 (2.5 0± 0.4 4 )log1 0 、(1 6 2± 1.12 )log1 0 和 (1 0 5± 1.35 )log1 0 。通过多因素分析 ,用干扰素 α-2a治疗 1个月后患者血清中HBV DNA阴转 ,提示干扰素 α-2a的疗效好 ;治疗前ALT高水平和无家族史也与其疗效好相关。结论 患者治疗 1个月后血清中HBV DNA定量是预测干扰素 α

Objective To evaluate the correlation between the efficacy of interferon-α-_(2a) and the kinetics of viral load in serum. Methods The authors conducted a trial including 58 patients with chronic hepatitis B. Patients were treated with interferon-α-_(2a) three times a week for 6 months. Viral kinetics were assessed by serial quantitive measurements of HBV-DNA. Results A significant decline of serum HBV-DNA was seen after interferon-α-_(2a) administration for 1 month,the decreases were (2.50±0.44) log_(10),(1.62±1.12)log_(10) and (1.05±1.35) log_(10) for complete responders, partial responders and no-responders, respectively. After 1 month of treatment, HBV-DNA level was (3.99±0.91) log_(10) for complete responders versus (5.63±1.31)log_(10) for partial responders, and (6.69±1.42)log_(10) for no-responders (P<0.05). Multivariate analysis suggested that undetectable serum HBV-DNA after 1 month of interferon-α-_(2a) treatment was associated with better efficacy; higher baseline ALT or/and no family history were also correlated with better treatment outcomes. Conclusion Kinetics of HBV-DNA level under interferon-α-_(2a) treatment are highly predictive of therapeutic response.