HBsAg定量对聚乙二醇干扰素治疗HBeAg阳性慢性乙型肝炎的预测

Evaluation of HBsAg quantification on the therapeutic effect of PEG-IFNα-2a for HBeAg positive chronic hepatitis B patients

目的评估聚乙二醇干扰素α-2a(PEG-IFNα-2a)治疗HBeAg阳性慢性乙型肝炎患者过程中乙肝病毒表面抗原(HBsAg)定量预测疗效的价值。方法 43例HBeAg阳性慢性乙型肝炎(CHB)患者,采用PEG-IFNα-2a治疗48周。分析基线HBsAg定量、HBeAg定量、ALT水平及HBV DNA载量对疗效的预测价值以及治疗后12周、24周HBV DNA载量及HBsAg定量对疗效的影响因素。受试者工作特征(ROC)曲线用于比较HBsAg和HBV DNA水平作为疗效的相对敏感性和特异性。结果 13例(30.23%)患者出现完全应答。48周病毒学完全应答与基线时的HBsAg定量、HBeAg定量、ALT水平及HBV DNA载量无关(P>0.05)。依据ROC曲线,结果显示24周时的血清HBsAg定量预测48周时完全应答的价值最好(AuC=0.821,P=0.001)。若以24周时HBsAg 1262IU/ml为界值,其48周时完全应答的敏感性与特异性分别为0.769和0.800。结论 HBsAg定量变化是聚乙二醇干扰素α-2a治疗e抗原阳性CHB过程中预测疗效有价值的指标。

Objective To assess the predictive value of HBsAg quantification on the therapeutic effect of PEG- IFNa-2a. for chronic hepatitis B （CHB） patients with positive HBeAg. Methods Forty-three HBeAg posi- tive CHB patients were treated with PEG-IFNα-2a for 48 weeks; The baseline HBsAg quantity, HBeAg quan- tity, ALT level and HBV viral load were analyzed for the predictive value on the therapeutic effect; Mean- while, HBV viral load and HBsAg quantity were also analyzed at 12 and 24 weeks after treatment. Receiver operating characteristic （ROC） curve was applied to compare the relative sensitivity and specificity of HBsAg quantification and HBV viral load which served as reference indicator on therapeutic effect of PEG-IFNa-2a. Results 13 patients （30. 23%） showed complete response. There was no direct correlation between complete virological response at 48 weeks and ALT, HBeAg quantity, HBV viral load at baseline （P 〉 0.05） . According to ROC curve, serum HBsAg quantification at 24 weeks could better predict the complete response at 48 weeks （AuC=0. 821, P=0. 001） . If the cutoff value of HBsAg at 24 weeks was 1 262 IU/ml, the sensi- tivity and specificity of complete response at 48 weeks would be 0. 769 and 0. 800. Conclusions HBsAg quantifica- tion is a valuable indicator on the therapeutic effect of PEG-IFN0c2a for HBeAg positive CHB patients.