性别是恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者完全病毒学应答的影响因素

Female is more likely to have complete virological response in Entecavir treatment among chronic hepatitis B patients with positive HBeAg

目的 探讨接受恩替卡韦治疗的HBeAg阳性慢性乙型肝炎（CHB）患者发生完全病毒学应答（CVR）的影响因素.方法 连续收集2009年12月至2014年5月于烟台市传染病医院接受恩替卡韦治疗的166例HBeAg阳性CHB患者的病例资料,回顾性分析患者年龄、性别、基因型、基线丙氨酸转氨酶（ALT）、HBV DNA载量、血清学标志物水平和恩替卡韦治疗后不同时间点CVR的累积发生率.CVR累积发生率采用Kaplan-Meier法,并用Log-rank检验比较不同影响因素下累积CVR的差异,同时用Cox比例风险回归模型探讨发生CVR的影响因素.结果 恩替卡韦治疗的HBeAg阳性CHB患者48、96、144和192周的CVR累积发生率分别为54.5％（87/157）、74.3％（106/129）、80.2％（109/119）和86.8％ （110/112）;Log-rank检验显示,女性、基因B型、基线ALT高水平和基线HBV DNA低载量患者CVR的累积发生率高于各项因素相应的对照组（x2=15.601,11.542,17.021和10.094,P值均＜0.01）,Cox风险回归模型提示仅女性是HBeAg阳性CHB患者恩替卡韦治疗后发生CVR的影响因素[风险比（HR）为3.015,95％可信区间（CI）：1.875 ～4.968,P＜0.01].结论 HBeAg阳性CHB患者完全病毒学应答率随恩替卡韦治疗时间的延长逐渐升高,且女性患者完全病毒学应答发生率更高.

Objective To investigate the associated factors of complete virological response （CVR） in Entecavir treatment among chronic hepatitis B （CHB） patients with positive HBeAg.Methods Data of 166 CHB patients with positive HBeAg receiving Entecavir treatment in Yantai Infectious Diseases Hospital during December 2009 and May 2014 were collected.Clinical data including age,gender,genotype,baseline alanine aminotransferase （ALT）,HBV DNA load,HBsAg and HBeAg levels as well as CVR cumulative rates at different time points during Entecavir treatment were retrospectively analyzed.The cumulative rate of CVR was estimated using Kaplan-Meier method,and the difference in cumulative CVR rates was studied with Log-rank test.Cox＆#39;s proportional hazards regression model was used to analyze the factors associated with CVR during Entecavir treatment.Results The cumulative rates of CVR during Entecavir treatment in HBeAg positive CHB patients were 54.5% （87/157）,74.3% （106/129）,80.2% （109/119） and 86.8% （110/112） at 48,96,144 and 192 weeks,respectively.Log-rank test showed that female patients and patients with genotype B,high baseline ALT level or low baseline HBV DNA load had higher CVR rates （x2 =15.601,11.542,17.021 and 10.094,all P 〈 0.01）.Cox＆#39;s proportional hazards regression model showed that female was the only associated factor for CVR in Entecavir treatment among HBeAg positive CHB patients [hazard ratio （HR） =3.015,95% confidence interval （CI）：1.875-4.968,P 〈 0.01].Conclusion CVR rate is increasing with the course of Entecavir treatment in HBeAg positive CHB patients,and CVR is more likely to occur in female patients.