聚乙二醇干扰素-α治疗HBeAg阳性慢乙肝的优化方案探索

Optimized Strategy of Peg-Interferon-α Treatment for Patients with Hepatits B E Antigen Positive Chronic Hepatitis B

目的评价根据聚乙二醇干扰素-α(Peg-IFN-α)治疗24周应答情况进行优化治疗的疗效。方法选取HBe Ag阳性慢性乙型肝炎(CHB)初治患者,观察组采用Peg-IFN-α,疗程24周HBV DNA下降≤2 log10 IU/m L定义为早期应答不佳,采取继续原方案(IFN亚组)或转用恩替卡韦(ETV)的不同策略;对照组使用ETV。每12周检测HBV DNA及乙肝病毒学标志物(HBV m)。结果观察组62例,有44例纳入早期应答不佳,其中29例纳入ETV亚组,15例纳入IFN亚组;对照组32例。疗程96周时,ETV亚组的HBe Ag血清学转换率达59%,高于对照组(25%)与IFN亚组(27%)(χ2=0.27、7.11,P=0.04、<0.01)。ETV亚组的HBs Ag下降幅度大于IFN亚组。结论根据Peg-IFN-α早期应答情况进行优化治疗可能提高HBe Ag血清学转换率。

OBJECTIVE To investigate the efficacy of optimal therapy strategies for hepatitis B e antigen（ HBe Ag） positive chronic hepatitis B（ CHB） patients with suboptimal response to Peg-interferon-α（ Peg-IFN-α） at 24-week. METHODS The cases of HBe Ag-positive CHB were enrolled into IFN group or entecavir（ ETV） group. Suboptimal response was defined as a decrease in HBV DNA of ≤2 log10 IU / mL after 24 weeks of IFN therapy. Based on patient preference,part of the patients with suboptimal response switched to ETV. Hepatitis B virus（ HBV） viralogical and serological data were collected every 12 weeks. RESULTS Among 62 patients in IFN group,44 hade suboptimal response. 29 cases switched to ETV and 15 cases went on Peg-IFN-α therapy. After 96 weeks of treatment,The patients switch-to ETV strategy had better HBe Ag seroconversion efficiency compared with go-on IFN strategy（ 59% vs27%,χ^2= 7.11,P〈0.01） or ETV group（ 59% vs 25%,χ^2= 0.27,P = 0.04）. The magnitude of HBs Ag decline was larger in switch-to ETV patients than that of go-on IFN patients. CONCLUSION The optimized treatment for CHB with suboptimal response to Peg-IFN-α could achieve a higher HBe Ag seroconversion rate.