恩替卡韦经治HBeAg阴性慢性乙肝患者联合聚乙二醇干扰素α-2b治疗的临床治愈疗效观察

The clinical cure efficacy of peginterferonα-2b add-on therapy in entecavir-treated patients with HBeAg-negative chronic hepatitis B

目的观察恩替卡韦经治HBeAg阴性慢性乙肝患者联合PEG-IFNα-2b治疗后HBsAg清除率。方法选取2017年4月至2018年6月就诊于厦门长庚医院的146例乙肝患者,根据不同治疗方式分为联合治疗组(恩替卡韦+PEG-IFNα-2b治疗,n=44)和恩替卡韦单药组(恩替卡韦治疗,n=102),比较两组HBsAg清除率和血清学转换率。结果联合治疗组有4例在24周时终止Peg-IFNα-2b治疗,24周时8例HBsAg阴转,3例发生HBsAg血清转换;48周时12例HBsAg阴转,6例HBsAg发生血清转换;23例HBsAg下降<1log,停PEG-IFNα-2b继续恩替卡韦治疗;其中5例HBsAg下降≥1log继续PEG-IFNα-2b及恩替卡韦治疗至72周,72周时累计15例HBsAg阴转(女4例,男11例),累计9例HBsAg发生血清转换,临床治愈率34.1%。其中,HBsAg滴度基线<350 IU/ml,12例获得临床治愈;联合治疗24周时HBsAg较基线下降≥1log,15例获得临床治愈。恩替卡韦单药组治疗72周,1例HBsAg阴转,临床治愈率为0.9%。无HBsAg血清转换发生。结论恩替卡韦经治HBeAg阴性慢性乙肝患者,联合PEG-IFNα-2b可显著提高HBsAg阴转率,获得临床治愈,其中HBsAg滴度基线<350 IU/ML、联合治疗24周HBsAg较基线下降≥1log的患者更易获得临床治愈。

Objective To observe the HBsAg loss rate of PEG-IFNα-2 b add-on therapy in entecavir(ETV)-treated patients with HBeAg-negative chronic hepatitis B.Methods 146 patients with hepatitis B who met the inclusion criteria and met the inclusion criteria in Xiamen Changgeng Hospital from April 2017 to June 2018 were selected,and they were divided into the combined treatment group(entecavir+PEG-IFNα-2 b treatment,n=44)and the entecavir monotherapy group(entecavir treatment,n=102),and the clearance rate and serological conversion rate between the two group were compared.Results 44 patients in the combined treatment group stopped PEG-IFNα-2 B treatment at 24 weeks,8 patients had HBsAg negative conversion,and 3 patients had HBsAg seroconversion at 24 weeks.At 48 weeks,12 patients had HBsAg negative conversion,and 6 patients had HBsAg seroconversion.23 patients with HBsAg decrease<1 log stopped PEG-IFNα-2 b and continued entecavir treatment;Five patients with HBsAg decrease≥1 log were continued with PEG-IFNα-2 b and entecavir treatment until 72 weeks.At the end of 72 weeks,15 patients(4 females,11 males)had HBsAg negative conversion,and 9 patients had seroconversion.The clinical cure rate was 34.1%.Among them,HBsAg titer baseline<350 IU/mL,12 cases were clinically cured;at 24 weeks of combined therapy,HBsAg decreased≥1 log from baseline,and 15 patients were clinically cured.In the entecavir monotherapy group,all patients were treated for 72 weeks,and 1 patient had negative HBsAg transformation.The clinical cure rate was 0.9%.No HBsAg seroconversion occurred.Conclusion PEG-IFNα-2 b significantly increased HBsAg loss rates of entecavir-treated patients with HBeAg-negative chronic hepatitis B,and the clinical cure can be achieved easier in patients with baseline HBsAg<350 IU/mL and/or a decrease of HBsAg≥1 log from baseline to 24 weeks of combination therapy.