联合用药治疗HBeAg阳性慢性乙型肝炎应答不佳患者疗效及安全性

Efficacy and safety of combination drug therapy in treatment of patients with HBeAg-positive chronic hepatitis B poor response

目的探讨阿德福韦酯联合聚乙二醇干扰素-2a治疗HBeAg阳性慢性乙型肝炎应答不佳者疗效及安全性,为临床诊治提供参考依据。方法选取80例HBeAg阳性慢性乙型肝炎患者,给予聚乙二醇干扰素-2α皮下注射治疗,治疗24周时根据HBV-DNA水平分为有应答反应组24例、应答不佳组56例,再将应答不佳组随机分为A、B组,每组各28例,A组加用阿德福韦酯治疗,B组仍原方案治疗,观察各组治疗前、治疗24、48周时相关指标变化及药物不良反应发生。结果治疗24周应答不佳组HBV-DNA、HBeAg高于有应答反应组(P<0.05);48周时A、B组、有应答反应组HBV-DNA转阴率分别为67.76%、39.29%、100.00%,HBeAg血清转阴率A、B组、有应答反应组分别为50.00%、21.43%、50.00%,A、B组及有应答反应组不良反应发生率分别为46.43%、32.14%、33.33%,各组比较差异无统计学意义。结论 HBeAg阳性慢性乙型肝炎患者聚乙二醇干扰素-2a治疗应答不佳时可联合使用阿德福韦酯,能明显提高HBV-DNA与HBeAg血清转阴率。

OBJECTIVE To observe the efficacy and safety of adefovir dipivoxil combined with pegylated interferon -2a in treatment of the patients with HBeAg-positive chronic hepatitis B poor response so as to provide guidance for the clinical diagnosis and treatment .METHODS A total of 80 patients with HBeAg-positive chronic hepatitis B were enrolled in the study and were treated with subcutaneous injection of pegylated interferon -2a .At 24 weeks of treatment ,the participants were divided into the response reaction group with 24 cases and the poor response group with 56 cases according to the level of HBV-DNA ,moreover ,the subjects in the poor response group were randomly divided into the group A and the group B ,with 28 cases in each ;the group A was treated with adefovir dipivoxil ,while the group B was given the original program .The changes of the related indicators and the inci-dence of drug-induced adverse reactions were observed before the treatment or at 24 ,48 hours of treatment . RESULTS At 24 weeks of treatment ,the levels of HBV-DNA and HBeAg of the poor response group were higher than those of the response reaction group （P〈 0 .05） .At 48 hours of treatment ,the negative rate of HBV-DNA was 67 .76% in the group A ,39 .29% in the group B ,100 .00% in the response reaction group ;the negative rate of serum HBeAg was 50 .00% in the group A ,21 .43% in the group B ,50 .00% in the response reaction group ;the incidence of adverse reactions was 46 .43% in the group A ,32 .14% in the group B ,33 .33% in the response reaction group ,there was no significant difference .CONCLUSION Adefovir dipivoxil combined with pegylated in-terferon -2a ,when used for the treatment of the patients with HBeAg-positive chronic hepatitis B ,can significant-ly raise the negative rate of both HBV-DNA and serum HBeAg .