慢性乙型肝炎患者抗病毒治疗过程中出现HBeAg/抗-HBe双阳性的临床意义

Clinical analysis of chronic hepatitis B with concurrent hepatitis e antigen and antibody during antiviral therapy

目的:分析慢性乙型肝炎(CHB)患者抗病毒治疗时发生HBe Ag/抗-HBe双阳性的临床意义。方法:回顾性分析115例CHB患者抗病毒治疗过程中出现HBe Ag/抗-HBe双阳性的CHB患者,其中50例接受聚乙二醇干扰素(PEG-IFN-α-2a)治疗,65例接受恩替卡韦(ETV)治疗。观察HBe Ag/抗-HBe双阳性发生时患者的生物化学、病毒学、血清学指标情况,以及临床转归。结果:115例患者纳入分析。PEG-IFN-α-2a组50例完成治疗后,6例(12.0%)发生HBs Ag阴转,31例(62.0%)患者发生HBe Ag血清学转换;ETV组无患者发生HBs Ag阴转,23例(35.4%)患者发生HBe Ag血清学转换,PEG-IFN-α-2a组HBs Ag阴转率和HBe Ag血清学转换率均高于ETV组(χ2=8.229,P=0.004;χ2=8.038,P=0.005)。结论:干扰素治疗出现HBe Ag/抗-HBe双阳性的CHB患者,最终发生HBs Ag阴转率和HBe Ag血清学转换率均高于ETV。

Objective To evaluate the clinical significance of chronic hepatitis B （CHB） with concurrent hepatitis e antigen （HBeAg） and antibody （anti-HBe） during antiviral therapy. Methods A total of 115 CHB patients with concurrent HBeAg and anti-Hbe detection during antiviral therapy were enrolled in this retrospective study. All patients received pegylated-IFN-alpha-2a （Peg-IFNα-2a, n = 50） or entecavir （ETV, n = 65） for antiviral treatment. Their biochemical virological and serological response and clinical outcome were detected and analyzed. Results Among the patients treated with Peg-IFNα-2a, 31 （62.0%） achieved HBeAg seroconversion and 6 （12.0%） achieved HBsAg seroconversion at the end of treatment. About 35.4% of patients, who received ETV, achieved HBeAg seroconversion and none of them achieved HBsAg seroconversion at the end of treatment （P 〈 0.05）. Conclusion High rates of HBeAg seroconversion and HBsAg loss could be achieved in CHB patients, with co-existence of HBeAg and anti-HBe, who received Peg-IFNα-2a, but not ETV therapy