摘要
目的探讨聚乙二醇干扰素(Peg-IFN)α-2a对核苷(酸)类似物在治疗获得部分病毒学应答且HBeAg仍为阳性的慢性乙型肝炎患者的疗效及影响疗效的相关因素。方法对核苷(酸)类似物在治疗中获得部分病毒学应答且HBeAg仍为阳性的慢性乙型肝炎患者进行Peg-IFNα-2a180μg每周皮下注射1次治疗;所有患者采用个性化疗程,对Peg-IFNα-2a治疗期间HBsAg和(或)HBeAg持续下降者则继续治疗。患者入组前及Peg-IFNα-2a治疗期间每3个月检测HBVDNA含量和血清学指标。以Peg-IFNα-2a治疗结束时HBsAg消失或血清学转换为主要疗效评价指标,HBsAg10IU/ml和HBeAg血清学转换为次要疗效评价指标。组间差异采用χ^2检验比较。使用受试者工作特征曲线下面积来评估干扰素治疗前基线血清HBsAg水平对干扰素治疗结束时〈10IU/ml的预测意义。结果共入组并治疗患者81例,核苷(酸)类似物治疗12.0(6.0~24.0)个月。Peg-IFNα-2a治疗19.6(15.5~33.3)个月;8.6%(7例)获得HBsAg消失或血清学转换,除HBsAg消失者外,另有17.3%(14例)达到HBsAg〈10IU/ml。HBeAg消失率为40.7%,HBeAg血清学转换率为38.3%。基线HBsAg〈1500IU/ml预测干扰素治疗结束时HBsAg〈10IU/ml的受试者工作特征曲线下面积=0.747,敏感度和特异度为87.3%和33.3%;阳性预测值和阴性预测值为82.1%和42.8%。结论Peg-IFNα-2a治疗可使经核苷(酸)类似物治疗获得部分病毒应答的HBeAg阳性慢性乙型肝炎的患者获得更高的免疫控制,基线HBsAg水平〈1500IU/ml可预测Peg-IFNα-2a的疗效。
Objective To investigate the efficacy and related factors of pegylated-interferon α-2a (PEG-IFN-2a) trealment in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) who achieved partial viral response with nucleoside analogue (NA) therapy. Methods Patients with HBeAg-positive CHB and partial viral response to NAlrealment were administered a PEG-IFN-2a therapy regimen of 180 g subcutaneous injection once weekly for a personalized dttrafion of lime. The existing NA therapy was continued in comb'marion with the new PEG-IFN-2a treamaent for 12 weeks. Measurements of serum HBV DNA load, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anfi-HBs), HBeAg and hepatitis B e antibody (anti-HBe) were taken at baseline (prior to addition of the PEGIFN-2a therapy) and every 3 months atterwards. For determining response to trealment, primary efficacy was defined as undetectable HBsAg and seroconversion, and secondary efficacy was defined as HBsAg 〈 10 1U/mL and HBeAg Statistical analysis was carried out using SPSS statistical software. Results A total of 81 consecutive patients with an average of 12.0 months (range: 6.0-24.0 months) of NA therapy were included in the study and received an average of 19.6 months (range: 15.5-33.3 months) of PEG-IFN-2a treamaent. At the end of PEG-IFN-2a therapy, 7 (8.6%) of the patients achieved undetectable HBsAg and seroconversion, and 14 (17.3%) showed HBsAg 〈 10 IU/mL. In addition, 40.7% achieved undetectable HBeAg and seroconversion, a rate that was slightly higher than that (38.3%) seen in Ireamaent-naive patients who received PEG-IFN-2a. Statistical analyses suggest that baseline level of HBsAg at 〈 1500 IU/mL may predict end of PEG-IFN-2a Irealment response for HBsAg 〈 10 IU/mL, as evidenced by the area under the curve measure of 0.747, sensitivity measure of 87.3%, specificity measure of 33.3%, positive predictive value of 82.1% and negative predictive value of 42.8%. Conclusion Patients with HBeAg-positive CHB and partial viral response to NA therapy can achieve undetectable HBsAg and HBeAg seroconversion afl~ switching to PEG-IFN-2a treatment. Baseline HBsAg level may be predictive of response to this therapeutic slrategy.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2015年第11期826-831,共6页
Chinese Journal of Hepatology
关键词
肝炎
乙型
慢性
干扰素
肝炎病毒
乙型
Hepatitis B, chronic
Interferons
Hepatitis B virus