干扰素α-2b与聚乙二醇干扰素α-2a治疗慢性乙型肝炎患者疗效比较研究

Comparative study of interferon alpha-2b and peginterferon alpha-2a in the treatm ent of patients with chronic hepatitis B

目的观察干扰素α-2b与聚乙二醇干扰素α-2a(PEG-IFNα-2a)治疗慢性乙型肝炎(CHB)患者的临床疗效。方法将116例CHB患者分成两组,每组58例。给予对照组普通干扰素α-2b治疗,给予观察组PEG-IFNα-2a,疗程均为48 w。检测血清层黏连蛋白(LN)、透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原肽(PⅢP)及血清白介素4(IL-4)、白介素6(IL-6)、白介素10(IL-10)和干扰素γ(IFN-γ)变化。结果在治疗结束时,观察组HBV DNA转阴率、HBeAg转阴率、HBeAg血清转换率和ALT复常率分别为75.9%、29.3%、22.4%和70.7%,显著高于对照组的51.7%、19.0%、10.3%和55.2%(P<0.05);观察组血清LN为(148.5±46.0)μg/L,显著低于对照组【(162.6±26.7)μg/L,P<0.05】,血清HA为(158.7±67.9)μg/L,显著低于对照组【(201.4±55.1)μg/L,P<0.05】,血清Ⅳ-C为(108.3±33.4)μg/L,显著低于对照组【(119.2±62.4)μg/L,P<0.05】,血清PⅢP为(145.8±47.2)μg/L,显著低于对照组【(155.3±36.7)μg/L,P<0.05】;观察组血清IL-4水平为(1.5±0.6)pg/ml,显著低于对照组【(3.9±1.6)pg/ml,P<0.05】,而IL-6水平为(6.9±1.3)pg/ml,显著高于对照组【(3.6±0.9)pg/ml,P<0.05】,IL-10水平为(22.6±13.4)pg/ml,显著低于对照组【(17.3±11.4)pg/ml,P<0.05】,IFN-γ水平为(37.2±10.2)pg/ml,显著高于对照组【(28.3±10.5)pg/ml,P<0.05】;观察组血小板计数减少发生率为51.7%,显著高于对照组的12.1%(P<0.05)。结论PEG-IFNα-2a治疗CHB患者临床疗效优于普通干扰素α-2b,能持久有效地抑制HBV复制,改善血清肝纤维化指标,但不良反应较大,应及时处理。

Objective To compare the efficacy of interferon alpha-2b and peginterferon alpha-2a(PEG-IFN alpha-2a)in the treatment of patients with chronic hepatitis B(CHB).Methods 116 patients with CHB were enrolled in our hospital between August 2015 and August 2017,and were divided randomly into two groups,with 58 in each.The patients in control were treated with interferon alpha-2b,and those in the observation group were treated with PEG-IFN alpha-2a.The regimen in both groups lasted for 48 weeks.Serum laminin(LN),hyaluronic acid(HA),collagen typeⅣ(Ⅳ-C)and pro-Ⅲtype collagen peptide(PⅢP)and serum interleukin 4(IL-4),IL-6,IL-10 and interferon gamma(IFN-gamma)were detected.Results Serum HBV DNA negative conversion,HBeAg negative conversion,serum HBeAg conversion to anti-HBe and ALT normalization rates in the observation group were 75.9%,29.3%,22.4%and 70.7%,all significantly higher than 51.7%,19.0%,10.3%and 55.2%,respectively(P<0.05);serum LN,HA,Ⅳ-C and PⅢP levels were significantly lower than in thecontrol(P<0.05);serum IL-4 level was significantly lower than,while serum IL-6,IL-10 and IFN-γlevels significantly higher than in the control(P<0.05);the incidence of thrombocytop nia was 51.7%,much higher than 12.1%in the control(P<0.05).Conclusion PEG-IFN alpha-2a might be superior to domestic IFN alpha-2b in the treatment of patients with CHB,which should be the first-line choice for antiviral therapy.