核苷类似物治疗e抗原阳性慢性乙型肝炎疗效的预测因素分析

Analysis of predictor for efficacy in nucleodise-treated E antigen-positive chronic hepatitis B

目的分析核苷类似物治疗e抗原阳性慢性乙型肝炎的基线特征及治疗初始阶段(24周)HBV-DNA的抑制程度对未来疗效的影响。方法 100例患者纳入分析,根据24周HBV-DNA水平将其分成阴性组(HBV-DNA<1.0×103copy/mL)和阳性组(HBV-DNA≥1.0×103copy/mL),分析两组基线特征及治疗初始阶段(24周)HBV-DNA抑制程度与治疗48周或72周疗效的相关性。结果 (1)阴性组基线HBV-DNA和ALT水平平均值分别为8.25 log10 copy/mL和167.0 u/L,而阳性组对应为8.71 log10 copy/mL与107.1 u/L,两组比较差异均有统计学意义(P<0.05);(2)治疗48周或72周阴性组各疗效指标即HBV-DNA转阴率、HBeAg血清转换率、ALT复常率、完全应答率和总有效率均优于阳性组,两组比较差异均有统计学意义(P<0.01);(3)阴性组治疗48周各疗效指标与治疗72周比较,差异均无统计学意义(P>0.05);阳性组治疗72周各疗效指标与治疗48周比较,差异均无统计学意义(P>0.05);(4)治疗48周或72周病毒反弹率阴性组和阳性组比较,差异无统计学意义(P>0.05);阴性组或阳性组治疗48周病毒反弹率与72周比较,差异无统计学意义(P>0.05)。结论核苷类似物治疗e抗原阳性慢性乙型肝炎治疗初始阶段(24周)HBV-DNA的抑制程度可借助治疗前HBV-DNA或ALT水平来预测,治疗初始阶段病毒的抑制程度可能与未来的疗效相关。

Objective To analyze the impact of baseline characteristics and the degree of treatment week 24（TW24） HBV suppression with nucleoside analogue treatment on the long-term outcomes for the patients with HBeAg-positive chronic hepatitis B.Methods One hundred patients with HBeAg-positive CHB were enrolled in the study.According to HBV-DNA level of every patient at TW24,those patients were divided into two groups：the negative group（HBV-DNA1.0×103 copy/mL） and the positive group（HBV-DNA≥1.0× 103 copy /mL）.We analyzed whether baseline characteristics and the degree of HBV suppression at week 24 were associated with therapeutic effect at weeks 48 or 72 between two groups.Results（1）There were the similar characteristics of sexuality and age in two groups patients.A majority of patients were men（73 percent）,mean age（28 years）.The mean baseline serum HBV-DNA and ALT levels were as follows：8.25 log10 copy/mL and 167.0 u/l in the negative group versus 8.71 log10 copy/mL and 107.1 u/l in the corresponding group.There were statistically differences in baseline HBV-DNA and ALT levels between two groups（P0.05）;（2）At week 48 or week 72,the efficacy of the negative group was superior to that of the positive group on HBeAg seroconversion,HBV suppression,aminotransferase（ALT） normalization,complete response or total effective rates（complete response and partial response）.The difference was statistically significant between two groups（P0.01）;（3）Compared with week 48,the differences were nor statistically significant in respect of the efficacy in positive group or negative group at week 72（P0.05）（4）There was no statistically significant difference in the change of the rates of virologic rebound not only between two groups at week 48 or week 72 but also between week 48 and week72 in positive group or negative group（P0.05）.Conclusion In e antigen-positive chronic hepatitis B patients treated with nucleoside analogue,the HBV-DNA suppression at the initial stage of TW24 is to draw assistance from pre-treatment HBV-DNA or ALT levels to predict.The degree of HBV-DNA suppression at week 24 maybe be associated with the prospective therapeutic effect