聚乙二醇干扰素初始联合核苷(酸)类似物治疗慢性乙型肝炎的疗效观察

Therapeutic efficacy of initial combination therapy with interferon and a nucleoside analogue for treating chronic hepatitis B patients

[目的]观察聚乙二醇干扰素初始联合核苷(酸)类似物治疗e抗原阳性慢性乙型肝炎(CHB)患者的疗效。[方法]对60例慢乙肝治疗患者进行研究,A组患者(n=29)使用聚乙二醇干扰素α-2a(Peg-IFNα-2a)联合阿德福韦酯治疗48周,B组患者(n=31)使用Peg-IFNα-2a联合阿德福韦酯及拉米夫定治疗48周。观察治疗过程中12、24、48周时患者ALT复常率、HBV-DNA应答率、HBeAg、HBsAg的转阴率和转换率。[结果]2组治疗结束时ALT复常率分别为82.8%(24/29)、83.9%(26/31),HBV-DNA应答率分别为86.2%(25/29)、90.3%(28/31),HBeAg血清学转换率分别为34.5%(10/29)、35.5%(11/31),HBsAg血清学转换率6.9%(2/29)、6.5%(2/31),差异无统计学意义(P>0.05)。[结论]Peg-IFNα-2a联合阿德福韦酯及拉米夫定治疗慢乙肝未显示疗效优势,初始全程Peg-IFNα-2a联合阿德福韦酯抗病毒治疗,可以提高病毒抑制的速度和血清学转换率。

[Objective]To observe the therapeutic efficacy of initial combination therapy with peginterferon and a nucleoside analogue for treating HBeAg-positive chronic hepatitis B（CHB）patients.[Methods]Sixty patients diagnosed with CHB were assigned to group A treated with peginterferon alpha-2a（PegIFNα-2a）combined with adefovir dipivoxil（n=29）and group B given with peginterferon alpha-2a combined with adefovir dipivoxil and lamivudine（n=31）.During the treatment ALT recovery rate,HBV-DNA response rate,HBeAg and HBsAg negative seroconversion rate and conversion rate were observed after 12,24,48 weeks.[Results]After treatment ALT recovery rate in group A and B was 82.8%（24/29）and 83.9%（26/31）respectively.The response rate of HBV-DNA was 86.2%（25/29）and 90.3%（28/31）,and HBeAg seroconversion rate was 34.5%（10/29）and 35.5%（11/31）,HBsAg seroconversion rate was 6.9%（2/29）and 6.5%（2/31）respectively（P〉0.05）.[Conclusion]The peginterferon alpha-2a combined with adefovir dipivoxil and lamivudine did not show advantage of curative effect in the treatment of chronic hepatitis B.Peg-IFN alpha-2a combined with adefovir dipivoxil antiviral therapy for the whole process at early stage can improve the speed of viral suppression and the serum conversion rate.