血清前白蛋白对慢性乙型肝炎干扰素疗效的预测作用

Serum prealbumin (PA) could serve as a predictor of interferon therapy in chronic hepatitis B

目的探讨血清前白蛋白(PA)能否作为预测干扰素治疗慢性乙型肝炎疗效的因素。方法 125例临床诊断为慢性乙型肝炎的患者,其中70例行肝穿刺活检,肝穿组炎症程度分为G1、G2、G3三组,所有病例均检测血清PA。所有患者均采用α-1b干扰素500MU皮下注射,隔日一次疗程2个月,停药后随访6个月。结果肝穿三组对干扰素的完全应答率随病理分级程度加重而逐步升高,差异有统计学意义(27.3%对68.3%,P<0.05);肝组织炎症分级越明显,血清前白蛋白水平越低,差异有统计学意义(179对212,P<0.01);所有病例(包括肝穿组及未肝穿组)随PA值逐渐升高,干扰素应答率逐渐降低,表明肝组织损伤轻者对干扰素应答差(28.6%对83.8%,P<0.01)。结论本研究再次验证了慢性乙型肝炎患者血清PA水平与肝组织病理炎症分级呈负相关:PA水平下降,炎症分级升高;PA水平接近正常,炎症分级低。PA水平能反映肝实质损伤程度;慢性乙型肝炎随肝病理分级上升或PA水平下降,干扰素应答率逐渐提高,提示血清PA水平可作为预测干扰素疗效的良好指标。

Objective To investigate the role of serum prealbumin （PA） in predicting the efficacy of interferon therapy in chronic hepatitis B.Methods Seventy patients out of 125 with clinically diagnosed as chronic hepatitis B received liver biopsy and were divided into three groups according to the degree of hepatic inflammation （named G1,G2 and G3 group）. Serum pre-albumin was detected in all cases. All patients received interferon α-1b 5 million units （50 μg）injection subcutaneously every other day for 12 months. They also received six-month follow-ups after therapy. Results The complete response rate to interferon for the three groups increased in consistent with the pathological severity. The difference was significant （27.3% vs. 68.3%,P〈0.05）. The higher the inflammation grade was,the lower the level of serum pre-albumin was. The difference was significant （179 vs. 212,P〈0.01）. The higher the level of PA in enrolled patients （including the 70 in the liver biopsy group and the left 55） the lower the interferon response rate,indicating that patients with less liver damage got poor interferon response （28.6% vs 83.8%,P〈0.01）.Conclusion Serum PA levels of chronic hepatitis B patients were negatively correlated with the inflammation grade of liver pathology. PA reduction was observed in the higher level of inflammation grade. Patients with PA level close to normal showed low-grade inflammation. PA levels can reflect the extent of liver damage. Patients with chronic hepatitis got higher interferon response when they show higher pathological grade or lower PA levels,which suggests that serum PA levels may be a good indicator predicting the response to interferon therapy.