替比夫定再治疗对α-干扰素无应答的慢性乙型肝炎患者血清转换和肝功能的影响

Effects of telbivudine re-treatment on seroconversion and liver function in patients with chronic hepatitis B and α-interferon non-response

目的:分析替比夫定再治疗对α-干扰素无应答的慢性乙型肝炎患者疗效。方法:选取2020年10月至2022年10月在咸宁市中医医院经聚乙二醇α-干扰素治疗6个月后无应答的72例慢性乙型肝炎患者,将其随机分为治疗组36例和对照组36例,对照组给予恩替卡韦治疗,治疗组采用替比夫定治疗,均治疗4个月。采用实时荧光定量PCR法检测血清HBV DNA载量。采用酶联免疫吸附法检测血清HBsAg和HBeAg。采用全自动生化分析仪检测血清谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBIL)水平。采用化学发光法测定血清透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、层粘连蛋白(LN)以及Ⅲ型前胶原(PC-Ⅲ)水平。采用反向杂交法检测耐药位点。结果:治疗组和对照组ALT复常率、HBV DNA转阴率、HBsAg转阴率和HBeAg转阴率差异无统计学意义(χ^(2)=0.084,0.215,0,0.348,均P>0.05)。治疗后,治疗组ALT[(42.27±6.65)U·L^(-1)]、AST[(38.32±5.64)U·L^(-1)]、TBIL[(29.25±4.62)μmol·L^(-1)]、LN[(184.21±20.61)U·L^(-1)]、HA[(123.28±13.45)μg·L^(-1)]、IV-C[(212.61±22.56)μg·L^(-1)]和PC-Ⅲ[(129.27±13.34)μg·L^(-1)]水平低于对照组[(64.65±8.79)U·L^(-1),(55.76±7.72)U·L^(-1),(54.81±6.47)μmol·L^(-1),(249.57±25.83)U·L^(-1),(166.37±16.56)μg·L^(-1),(242.39±25.34)μg·L^(-1),(154.82±15.78)μg·L^(-1)](t=12.193,10.945,19.290,11.868,12.119,5.267,7.418,均P<0.05)。两组耐药率和总不良反应率差异无统计学意义(均P>0.05)。结论:α-干扰素无应答的慢性乙型肝炎患者应用替比夫定再治疗后获得较好疗效,有效改善肝功能和肝纤维化。

Objective:To analyze the curative effect of telbivudine re-treatment on patients with chronic hepatitis B and α-interferon non-response.Methods:A total of 72 patients with chronic hepatitis B and non-response after 6 months of polyethylene glycolα-interferon therapy in the Xianning City Hospital of Traditional Chinese Medicine were enrolled between October 2020 and October 2022,and they were randomly divided into observation group(36 cases)and control group(36 cases).The control group was treated with entecavir,while observation group was treated with telbivudine for 4 months.The load of serum HBV DNA was detected by real-time fluorescence quantitative PCR.The levels of serum HBsAg and HBeAg were detected by enzyme-linked immunosorbent assay.The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)were detected by full-automatic biochemical analyzer.The levels of serum hyaluronic acid(HA),type Ⅳ collagen(Ⅳ-C),laminin(LN)and type Ⅲ procollagen(PC-Ⅲ)were detected by chemiluminescence method.The drug resistance sites were detected by reverse hybridization.Results:There was no significant difference in ALT normalization rate,HBV DNA negative conversion rate,HBsAg negative conversion rate and HBeAg negative conversion rate between the treatment group and the control group(χ^(2)=0.084,0.215,0,0.348,all P>0.05).After treatment,the levels of ALT,AST,TBIL,LN,HA,IV-C and PC-Ⅲ in the treatment group(ALT(42.27±6.65)U·L^(-1),AST(38.32±5.64)U·L^(-1),TBIL(29.25±4.62)μmol·L^(-1),LN(184.21±20.61)U·L^(-1),HA(123.28±13.45)μg·L^(-1),Ⅳ-C(212.61±22.56)μg·L^(-1),PC-Ⅲ(129.27±13.34)μg·L^(-1))were lower than those in the control group((64.65±8.79)U·L^(-1),(55.76±7.72)U·L^(-1),(54.81±6.47)μmol·L^(-1),(249.57±25.83)U·L^(-1),(166.37±16.56)μg·L^(-1),(242.39±25.34)μg·L^(-1),(154.82±15.78)μg·L^(-1))(t=12.193,10.945,19.290,11.868,12.119,5.267,7.418,all P<0.05).There was no significant difference in drug resistance rate or total incidence of adverse reactions between the two groups(P>0.05).Conclusion:The curative effect of telbivudine re-treatment is good on patients with chronic hepatitis B andα-interferon nonresponse,which can effectively improve liver function and liver fibrosis.