对普通干扰素无应答的HBeAg阳性慢性乙型肝炎患者给予延长聚乙二醇干扰素疗程的疗效分析

Efficacy of extending pegylated interferon treatment in HBeAg positive chronic hepatitis B patients with normal interferon non-response

目的探析普通干扰素无应答的HBeAg阳性慢性乙型肝炎患者给予延长聚乙二醇干扰素疗程治疗的临床效果。方法将台州市中心医院2013年8月~2015年8月确诊并收治的74例慢性乙型肝炎且应用普通干扰素治疗应答失败患者按照随机数字表法分为研究组和对照组,每组37例。研究组均给予72 w的聚乙二醇干扰素α-2a皮下注射治疗,对照组给予48 w的聚乙二醇干扰素α-2a皮下注射治疗,2组干扰素治疗期间给予水飞蓟宾保肝。治疗结束后半年实施随访,观察2组治疗后及随访时HBsAg转阴率、HBV-DNA转阴率、HbeAg血清转换率及丙氨酸氨基转移酶（ALT）水平恢复正常率。观察2组治疗期间不良反应。结果研究组治疗后及随访时HBsAg转阴率、HBV-DNA转阴率、HbeAg血清转换率显著优于对照组（P〈0.05）,2组治疗后及随访时ALT水平差异均无统计学意义。研究组与对照组不良反应率比较差异无统计学意义（16.22%vs.10.81%）。结论普通干扰素无应答的HBeAg阳性慢性乙型肝炎患者给予聚乙二醇干扰素其临床疗效确切,而在常规48 w疗程基础上将其疗程延长至72 w,可获得更为满意的疗效,且不会显著降低安全性。

Objective To explore the clinical effect of extending pegylated interferon treatment in the treatment of HBeAg positive chronic hepatitis B patients with normal interferon non-respond. Methods 74 cases of patients with chronic hepatitis B who were diagnosed and treated in our hospital from August 2013 to August 2015 were divided into study group and control group according to the random number table method, 37 cases in each group. Study group were given 72 weeks of pegylated interferon alfa-2a subcutaneous injecdon, the control group received 48 weeks of peginterferon alfa- 2a subcutaneous injection, and the two groups were given silybin for hepatoprotective treatment during interferon therapy. After treatment, the two groups were followed up six months later. The HBsAg negative conversion rate, HBV-DNA negative rate, HBeAg serum conversion rate and alanine aminotransferase （ALT） levels returned to normal rate. Adverse reactions were observed during the treatment. Results The HBsAg negative conversion rate, HBV-DNA negative rate and HBeAg serum conversion rate in study group after the treatment and follow-up were significantly better than the control group （ P 〈 0. 05 ）, the ALT levels had no significant difference between two groups after treatment and follow-up. The adverse reaction rate of the study group was 16. 22% , the adverse reaction rate of the control group was 10. 81% , and there was no significant difference in adverse reaction rates between the two groups. Conclusion HBeAg positive chronic hepatitis B of patients with common interferon non-response has the exact clinical curative effect who receive pegylated interferon, and prolonging the course from conventional 48 week to 72 weeks, which could obtain satisfacting curative effect and not significantly reduce safety.