病毒学因素对聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎e抗原血清学转换的影响

Viral Factors Influencing HBeAg Seroconversion in Patients with HBeAg-positive Chronic Hepatitis B Treated with Peg-Interferon α

目的:探讨聚乙二醇干扰素α(PEG-IFNα)治疗乙型肝炎病毒e抗原(HBeAg)阳性患者的疗效及各种病毒学因素与HBeAg血清学转换的关系。方法:216例HBeAg阳性慢性乙型肝炎(CHB)患者皮下注射PEGIFNα,每周1次,治疗48周,随访24周。治疗前所有患者检测基线HBsAg、HBeAg、HBV-DNA定量,部分患者分析HBV基因型及P区位点变异情况。治疗结束后统计HBeAg的血清学转换情况,并分析各种病毒学因素与e抗原血清学转换的关系。结果:216例患者治疗48周时68例(31.48%)发生e抗原血清学转换。基线HBsAg定量<250 ng/mL患者的e抗原血清学转换率显著高于HBsAg定量≥250 ng/mL(χ2=4.293,P=0.038)。e抗原血清学转换组基线HBeAg和HBV-DNA定量显著低于非血清学转换组(t=4.455,P=0.000;t=1.974,P=0.046)。B、C型的e抗原血清学转换率差异不大(χ2=0.497,P=0.481)。野生型、非204位点变异患者的e抗原血清学转换率虽高于204位点变异者,但差异均无统计学意义(P均>0.05)。结论:病毒学各因素中,基线HBsAg、HBeAg、和HBV-DNA定量是聚乙二醇干扰素α治疗HBeAg阳性慢性乙型肝炎疗效的较重要影响因素,HBV基因型(B、C型)及P区位点变异对其影响不大。

Objective ： To investigate the efficiency of peg - interferon α therapy to HBeAg - positive chronic hepatitis B and explore the relationship between the viral factors and HBeAg seroconversion. Methods ：216 HBeAg -positive chronic hepatitis B patients were treated with peg - interferon α once a week for 48 weeks and followed up for 24 weeks. Before treatment,the HBsAg, HBeAg and serum HBV DNA 1 evels of all patients were detected, and the HBV genetype and varia- ble sites in P zone of some patients were determined. The rate of HBeAg seroconversion was calculated after therapy, and the viral factors influencing HBeAg seroconversion were analyzed. Results ：The rate of HBeAg seroconversion was 31.48% at the end of treatment. The rate of HBeAg seroconversion in patients whose HBsAg level was smaller than 250 ng/mL was much higher than that in patients whose HBsAg level was greater than or equal to 250 ng/mL（ X^2 = 4. 293 ,P = 0. 038 ）. The HBeAg and serum HBV DNA 1 evels in HBeAg seroconversion group were much higher than that of HBeAg non - se- roconversion group（t = 4. 455,P = 0. 000;t = 1. 974, P = 0. 046）. The rate of HBeAg seroconversion had no statistical difference in patients with genetype B and C（ X^2 =0. 497 ,P =0. 481 ）. The rate of HBeAg seroconversion in patier, ts with wild type and non - 204 variation was higher than those with 204 variation, but it had no statistical difference （ all P 〉 0. 05 ）. Conclusion ： Among above viral factors, the base HBsAg, HBeAg and serum HBV DNA 1 evels are much importantfactors influencing the effect of Peg - interferon α therapy than HBV genetype and variable sites of P zone.