聚乙二醇干扰素α-2a治疗HBeAg阳性慢性乙型肝炎的疗效预测指标

Predictor Analysis of Efficacy of Peginterferon Alfa-2a in HBeAg-positive Chronic Hepatitis B

目的探讨聚乙二醇干扰素α-2a(PEG-IFNα-2a)治疗HBeAg阳性慢性乙型肝炎(CHB)的临床疗效预测指标。方法回顾性分析接受聚乙二醇干扰素α-2a治疗至少48周的HBeAg(+)CHB患者的临床疗效,按治疗48周时发生血清学应答与否分成A组与B组,比较两组治疗前(基线)和治疗4,12,24周的丙氨酸氨基转移酶(ALT)水平、HBV-DNA载量及下降幅度、HBeAg定量及下降幅度。结果 A组基线ALT水平明显高于B组(P<0.01),而治疗4,12,24周两组ALT水平均差异无统计学意义(P>0.05);不同时期两组的HBV-DNA载量对数值及降幅均差异有统计学意义(P<0.05)。两组治疗12,24周的HBeAg定量及降幅差异有统计学意义(P<0.01),下降≥2log10者48周血清学应答率较高。结论 HBeAg(+)CHB患者基线ALT水平、治疗过程HBV-DNA载量及降幅和治疗12,24周的HBeAg定量及降幅对聚乙二醇干扰素α-2a治疗48周的血清学应答具预测作用。

Objective To explore the factors predicting the response to the treatment of HBeAg-positive chronichepatitis B （ CHB） with Peginterferon alfa-2a （ PEG-IFN-α-2a）. Methods Clinical efficiency of PEG-IFN-α-2a in treatingHBeAg （＋） CHB patients for at least 48 weeks was retrospectively analyzed. The patients were divided into groups A and Baccording to the serological response. The ALT levels, HBV-DNA load, and HBeAg at the baseline and 4, 12 and 24 weeks afterthe treatment were compared. Results ALT at the baseline was significantly higher in group A than in group B （P〈0. 01）.After treatment for 4, 12, and 24 weeks, there was no difference in ALT between the two groups. There were significantdifferences in HBV-DNA load and its decrement between the two groups during different time of treatment （P〈0. 05）. There weresignificant differences in HBeAg level and its decrement between the two groups after treatment for 12 and 24 weeks （P〈0. 01）.Serological response rate was higher in patients with HBeAg decrement higher than 2log10 . Conclusion Baseline ALT levels,HBV-DNA load and the decrement during the treatment, HBeAg levels and the decrement after treatment for 12 and 24 weeks arepredictive for serological response after treatment with PEG-IFN-α-2a for 48 weeks in CHB patients.