回顾性分析聚乙二醇干扰素治疗HBeAg阳性慢性乙型肝炎患者抗病毒方案调整分析

Retrospective analysis of adjustment of antiviral programs for HBeAg-positive chronic hepatitis B patients treated with pegylated interferons

目的探讨聚乙二醇干扰素(PEG-IFN)治疗HBeAg阳性慢性乙型肝炎(CHB)患者的抗病毒方案调整情况及临床疗效,为临床提供参考。方法回顾性分析2006年7月-2015年8月接受PEG-IFN治疗的HBeAg阳性CHB患者98例,分别依据抗病毒方案调整情况及时间、干扰素治疗时间等进行分组,了解各种治疗方案调整的人数、原因,并比较各组基线情况及累计HBeAg血清学转换率。结果 98例患者聚乙二醇干扰素使用时间为平均12个月,随访时间为平均24个月,累积HBeAg血清转换率达到51%;在12个月内单用干扰素,改用或者联用NAs的患者分别有56例、15例及27例,其中3例为干扰素副作用而调整,改用和联用核苷(酸)类似物(NAs)的种类多样;无论按照是否改用或联用NAs分组、干扰素使用时间长短分组、更改为NAs时间分组或开始联合治疗时间分组,各种分组的基线指标(ALT、HBeAg和HBV DNA等)均无统计学差异,经生存曲线分析后发现,各种分组患者治疗随访期间累计HBeA转换率差异均无统计学意义。结论 PEG-IFN治疗HBeAg阳性CHB的各抗病毒调整方案存在且随意性较大,各种调整方案的血清学转换率差异较小。

OBJECTIVE To explore the adjustment of antiviral programs for HBeAg-positive chronic hepatitis B（CHB）patients treated with pegylated interferons（PEG-IFN）and observed the clinical effects so as to provide guidance for clinical treatment.METHODS A total of 98 HBeAg-positive CHB patients who were treated with PEG-IFN from Jul 2006 to Aug 2015 were retrospectively analyzed,the enrolled patients were grouped according to the adjustment and time of the antiviral programs and time of interferon therapy.The number of patients involved in and causes of adjustment of treatment programs were investigated,the baseline data and cumulative HBeAg serological conversion rate were observed and compared.RESULTS The mean duration of PEG-IFN therapy of the 98 patients was 12 months,the mean follow-up time was 24 months,and the cumulative HBeAg serological conversion rate reached up to 51%.There were 56 patients who were treated with single interferon,15 patients who switched to be treated with NAs,and 27 patients who were treated with interferon combined with NAs,the therapy of 3patients was adjusted due to the side effect of interferon,the nucleos（t）ide analogues（NAs）that were switched to and combined were diversified.Whatever the patients were grouped based on the use of NAs,time of use of interferons,time of switching to NAs or time of initial combined treatment,there was no significant difference in the baseline indexes（ALT,HBeAg,and HBV DNA）.The survival curve analysis showed that there was no significant difference in the cumulative HBeA conversion rate among the groups during the follow-up period.CONCLUSION The antiviral programs are adjusted randomly for the HBeAg-positive CHB patients treated with PEG-IFN,and there is a little difference in the serological conversion rate among the adjusted programs.