聚乙二醇干扰素应答不佳HBeAg阴性慢性乙肝患者加用拉米夫定或阿德福韦酯疗效观察

The effect of LAM or ADV add-on therapy for HBeAg negative chronic hepatitis B patients with suboptimal response to PEG-IFN

目的 观察聚乙二醇干扰素应答不佳的HBeAg阴性慢性乙肝患者加用拉米夫定或阿德福韦酯后的抗病毒疗效.方法 将110例接受聚乙二醇干扰素治疗12周应答不佳的患者,随机分组分别联合拉米夫定、阿德福韦酯进行抗病毒治疗,观察两组在继续治疗12周、24周、48周时血清HBsAg定量、HBV-DNA阴转率、ALT复常率、血清Ⅲ型前胶原（PC Ⅲ）、层粘连蛋白（LN）指标,并进行统计学分析.结果 两组患者分别在治疗12周、24周、48周时血清HBsAg定量逐渐下降,HBV-DNA阴转率增加、ALT复常率提高,各治疗节点间比较有统计学差异（P＜0.05）;治疗12、24、48周时血清纤维化指标（PC Ⅲ、LN）亦逐渐下降,各治疗节点间比较有统计学差异（P＜0.05）;两组间血清HBsAg定量在各治疗节点下降情况、HBV-DNA阴转率、ALT复常率均无统计学差异（P＞0.05）;两组间血清纤维化指标（PC Ⅲ、LN）在各治疗节点下降情况无统计学差异（P＞0.05）.患者血清HBsAg定量与血清肝纤维化指标PC Ⅲ、LN之间呈正相关,相关系数分别为0.756、0.782（P值均＜0.05）.结论 在聚乙二醇干扰素应答不佳的e抗原阴性慢性乙肝患者中,加用拉米夫定或阿德福韦酯后均能有效抗病毒及抗纤维化治疗.

Objective To evaluate the effect of LAM or ADV add-on therapy for HBeAg negative chronic hepatitis B patients with suboptimal response to PEG-IFN.Methods 110 cases of HBeAg negative chronic hepatitis B patients with suboptimal response to PEG-IFN 12 week＆#39;s treatment were divided into 2 groups, LAM add-on group and ADV add-on group.All patients were treated for 48 weeks.Hepatitis B virus （HBV） virological and serological data were collected at 12 weeks, 24 weeks and 48 weeks after the initiation of optimal therapy.Results The HBsAg quantitative and serum fibrosis index（PC Ⅲ 、LN） decrease, rate of undetectable HBV DNA and ALT normalization increased through treatment from 12 weeks, 24 weeks to 48 weeks.The differences were significant（P 〈 0.05）.However, the difference was not significant between 2 groups（P 〉 0.05）.The HBsAg quantitative rate was positive correlated with serum fibrosis index（PC Ⅲ and LN）, the correlation coefficient were 0.756 and 0.782, respectively（P 〈 0.05）.Conclusions LAM or ADV add-on therapy for HBeAg negative chronic hepatitis B patients with suboptimal response to PEG-IFN was an effective anti-viral and anti-fibrotic remedy.