核苷（酸）类似物序贯干扰素治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎患者的临床观察

Increase of hepatitis B surface antigen loss rate in hepatitis B e antigen positive chronic hepatitis B patients treated with nucleos （t） ide analogs and pegylated interferon alfa-2α sequential therapy

目的观察HBeAg阳性慢性乙型肝炎（CHB）患者在核苷（酸）类似物抗病毒治疗基础上序贯聚乙二醇干扰素α-2α（PEGIFNα-2α）治疗48周血清HBsAg的变化。方法6例HBeAg阳性CHB患者中，3例采用核苷（酸）类似物序贯PEGIFNα-2α治疗48周，3例维持原核苷（酸）类似物治疗方案，每12周采用实时PCR定量检测HBVDNA，采用时间分辨免疫荧光分析法检测HBsAg、抗HBs、HBeAg、抗-HBe及抗-HBc。结果核苷（酸）类似物序贯PEGIFNα-2α治疗48周后，3例序贯治疗患者血清HBsAg均消失，而维持原核苷（酸）类似物治疗患者血清HBsAg效价为100～320IU／mL。结论对核苷（酸）类似物治疗产生较好应答反应且伴有血清HBsAg效价明显下降的HBeAg阳性CHB患者，在核苷（酸）类似物抗病毒治疗基础上序贯PEGIFNα-2α治疗48周能有效促进血清HBsAg下降，并出现血清HBsAg消失的现象。

Objective To investigate the changes of hepatitis B sarfaceantigen （HBsAg） titer in hepatitis B e antigen （HBeAg） positive chronic hepatitis B （CHB） patients treated with nucleos（t）ide analogs and pegylated interferon alfa-2a （PEG IFNα-2α） sequential therapy. Methods Among 6 HBeAg positive CHB patients, 3 patients were treated with nucleos（t）ide analogs followed by PEG IFNα-2α for 48 weeks, 3 patients were treated with nucleos（t）ide analog monotherapy. The serum HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBc were detected using the time-resolved immunofluorometrie assay and serum hepatitis B virus （HBV） DNA levels were determined by Taqman polymerase chain reaction （PCR） every 12 weeks. Results HBsAg loss were achieved in three patients after 48-week nucleos（t）ide analogs and PEG IFNα-2α sequential therapy. However, the HBsAg titers of another 3 patients varied from 100 IU/mL to 320 IU/mL. Conclusion In HBeAg positive CHB patients who obtain virologic response accompanied with HBsAg titer decreasing dramatically by nueleos（t）ide analog treatment, PEG IFNα-2α sequential treatment can increase HBsAg clearance rate.