肝组织病理及肝内抗原表达与聚乙二醇干扰素α-2a抗乙肝病毒疗效关系的研究

The correlation among antiviral efficacy and intrahepatic viral antigen expression and histology in patients with chronic hepatitis B received pegylated interferon α-2a treatment

目的观察聚乙二醇干扰素α-2a(PegIFNα-2a)治疗慢性乙型肝炎的疗效,探讨肝脏病理改变和肝细胞内病毒抗原的表达类型与PegIFNα-2a抗病毒疗效的关系。方法选择HBeAg阳性慢性乙型肝炎68例,HBeAg阴性慢性乙型肝炎45例,通过肝组织病理检测,观察肝脏病理改变和肝细胞内病毒抗原的表达类型与PegIFNα-2a治疗后血清HBV DNA的阴转率、HBeAg转换率和完全应答率之间的关系,并随访48周,观察持续应答情况。结果 HBsAg的阴转在不同的炎症活动度间差异无统计学意义;在HBeAg阳性患者中,G1组的HBeAg转换率和完全应答率与G3组比较差异有统计学意义(P均<0.05);炎症活动度高的病例经治疗后48周的持续应答率高于炎症活动度低的病例(χ2=4.311,P<0.05);肝细胞内HBcAg浆型表达者HBeAg阴转、HBeAg转换率、HBV DNA的阴转率均高于HBcAg核型表达者(P均<0.05)。结论肝组织病理改变和病毒抗原在肝细胞的表达类型可能成为PegIFNα-2a抗病毒疗效的潜在预测因素。炎症活动度高、肝细胞内HBcAg浆型表达者可能对PegIFNα-2a的治疗应答更好。

Objective To investigate the antiviral efficacy of pegylated interferon α-2a on chronic hepatitis B（CHB）,and explore the relationship among the change in hepatic pathology,intrahepatic viral antigen expression and antiviral efficacy.Methods 113 patients with chronic hepatitis B were included in the study,of which 68 patients were HBeAg positive,and 45 were HBeAg negative.Furthermore,the hepatic pathology and intrahepatic viral antigen expression were determined through liver biopsy and immunohistochemistry.The rates of undetectable HBV DNA,HBeAg seroconversion and complete response after therapy with pegylated interferon α-2a were determined and all cases were followed up for 48 weeks combined with the results of liver histology were comprehensively analyzed.Results HBsAg negative conversion rates of patients with different degree of inflammation were significantly different.Among the HBeAg positive patients（P〈0.05）,the HBsAg seroconversion rates were significantly different between G1 and G3（P〈0.05）.The sustained responsive rate at 48 weeks after treatment of the patients with higher degree of inflammation was higher than that of the patients with a lower degree of inflammation（χ2=4.311,P〈0.05）.The HBeAg negative conversion rate,HBeAg seroconversion rate,HBV DNA negative conversion rate of the patients with HBcAg expressed in the hepatic plasma were higher than those of the patients with HBcAg expressed in the hepatic nuclei（P〈0.05）.Conclusion The change in liver histology and the pattern of viral antigen expression in hepatocyte could be considered as the potential indicators in the evaluation of the efficacy of pegylated interferon α-2a treatment.In other words,patients with higher inflammatory activity and HBcAg expressed in hepatic plasma would have a more effective therapeutic response.