聚乙二醇干扰素α-2a联合恩替卡韦治疗CHB的效果及对肝功能和肝纤维化的影响

Effect of PegIFNα-2a combined with entecavir on CHB and its effects on liver function, liver fibrosis

目的观察聚乙二醇干扰素α-2a(PegIFNα-2a)联合恩替卡韦治疗慢性乙型肝炎(CHB)的临床效果。方法回顾性分析2013年11月-2018年1月四川省遂宁市中心医院感染科诊治CHB患者48例的临床资料,采用PegIFNα-2a联合恩替卡韦方案者纳入联合组(n=27),单用恩替卡韦进行治疗者纳入对照组(n=21)。治疗48周后,比较2组阴转率、肝功能(Child-Pugh肝功能分级)、肝纤维化指标、肝脏硬度(LSM)值、细胞免疫指标水平变化及药物不良反应发生率差异。结果治疗48周后,联合组HBV DNA转阴率明显高于对照组(66.7%vs.38.1%,χ^2=3.884,P=0.049),而2组HBsAg、HBeAg/HbeAb、HBcAb转阴率比较差异均无统计学意义(P>0.05);2组Child-Pugh肝功能分级、LSM值及血清LN、PCⅢ、HA水平均较治疗前有显著下降,且联合组明显低于同期对照组(Z/P=2.024/0.043,t/P=4.014/<0.001、2.222/0.031、2.051/0.046、2.150/0.037);2组外周血CD4^+/CD8^+、NK细胞水平均较治疗前有显著提升,且联合组明显高于同期对照组(t/P=2.971/0.005、2.319/0.025);治疗48周内,2组血小板减少、贫血、甲状腺功能异常、头痛、恶心等并发症发生率比较差异均无统计学意义(P>0.05)。结论PegIFNα-2a联合恩替卡韦应用于CHB可获得较为理想的治疗效果,对改善患者肝功能、肝纤维化及LSM值有利,为高病毒载量CHB临床治疗提供新思路。

Objective To observe the clinical effect of pegIFN alpha-2a combined with entecavir in the treatment of chronic hepatitis B(CHB).Methods Retrospective analysis of clinical data of 48 patients with CHB diagnosed in the Department of Infectious Diseases,Suining Central Hospital,Sichuan Province from November 2013 to January 2018.Patients with PegIFNα-2 a plus entecavir were included in the combination group(n=27)and treated with entecavir alone.The patients were included in the control group(n=21).After 48 weeks of treatment,the negative conversion rate,liver function(Child Pugh liver function grading),liver fibrosis index,liver stiffness(LSM)value,cellular immune index level and the incidence of adverse drug reactions were compared between the two groups.Results After 48 weeks of treatment,the negative conversion rate of HBV DNA in the combined group was significantly higher than that in the control group(66.7%vs.38.1%,χ^2=3.884,P=0.049),while the negative rates of HBsAg,HBeAg/HbeAb,and HBcAb in the two groups were significantly different.There was no statistical significance(P>0.05).The liver function grading,LSM value and serum LN,PCIII and HA levels of the two groups were significantly lower than those before treatment,and the combination group was significantly lower than the control group(Z/P=2.024/0.043,t/P=4.014/<0.001,t/P=2.222/0.031,t/P=2.051/0.046,t/P=2.150/0.037);the levels of CD4^+/CD8^+and NK cells in the peripheral blood of the two groups were significantly higher than those before treatment,and the combined group was significantly higher.In the same period of the control group(t/P=2.971/0.005,t/P=2.319/0.025);within 48 weeks of treatment,the incidence of complications such as thrombocytopenia,anemia,thyroid dysfunction,headache,nausea was not found in the two groups.Statistical significance(P>0.05).Conclusion PegIFNα-2a combined with entecavir can be used in CHB to obtain ideal therapeutic effect,which is beneficial to improve liver function,liver fibrosis and LSM value,and provides a new idea for clinical treatment of high viral load CHB.