核苷(酸)类似物联合聚乙二醇干扰素治疗慢性乙型肝炎实现临床治愈的影响因素分析

Influencing factors of efficacy of nucleos(t)ide analogues and Peg IFNα-2a combination therapy for patients with chronic hepatitis B

目的探究核苷(酸)类似物[nucleos(t)ide analogues,NAs]联合聚乙二醇干扰素(pegylated interferon,Peg IFN)α-2a治疗慢性乙型肝炎(chronic hepatitis B,CHB)实现临床治愈的影响因素。方法收集2013年1月1日至2023年12月1日在浙江大学医学院附属第一医院感染科门诊就诊并接受NAs与Peg IFNα-2a联合治疗≥48周的141例CHB患者临床资料,并进行回顾性分析。根据疗效分为临床治愈组(n=45)和临床未治愈组(n=96),通过多因素Logistic回归分析临床治愈的影响因素。结果多因素分析显示,基线HBsAg<1500 IU/mL(OR=0.160,95%CI 0.049~0.522,P=0.002)、第48周HBsAg相比基线下降>1 lg IU/mL(OR=0.114,95%CI 0.027~0.484,P=0.003)、使用经治策略(OR=0.351,95%CI 0.128~0.960,P=0.041)是预测联合治疗疗效的影响因素。结论经治策略疗效优于初治策略,治疗基线HBsAg水平<1500 IU/mL的病例相较基线水平高者更有希望获得临床治愈,基础疗程建议为48周,并可在48周时根据HBsAg下降程度评估是否延长治疗时间。

Objective To explore the influencing factors of efficacy of combination therapy of nucleos(t)ide analogues(NAs)with pegylated interferonα-2a(Peg IFNα-2a)for patients with chronic hepatitis B(CHB).Methods The clinical data of 141 CHB patients receiving combination therapy of NAs and Peg IFNα-2a for≥48 weeks in the First Affiliated Hospital of Zhejiang University School of Medicine from January 1,2013 to December 1,2023 was retrospectively analyzed.Patients were divided into clinical cure group(n=45)and non-clinical cure group(n=96).Multivariate Logistic regression analysis was used to analyze the influencing factors of clinical cure.Results Multivariate Logistic regression analysis showed that baseline HBsAg<1500 IU/mL(OR=0.160,95%CI 0.049-0.522,P=0.002),a decrease by>1 lg IU/mL in HBsAg at week 48 compared to the baseline level(OR=0.114,95%CI 0.027-0.484,P=0.003),and sequential combination therapy(OR=0.351,95%CI 0.128-0.960,P=0.041)were independent predicting factors for the efficacy of combination therapy of NAs and Peg IFNα-2a in CHB patients.Conclusions The study indicates that the efficacy of the sequential combination therapy is superior to that of the treatment-naïve therapy,and patients with baseline HBsAg<1500 IU/mL is more likely to achieve clinical cure than those with higher baseline levels.A primary course of 48 weeks was recommended,with the possibility of an extension of the course by evaluating the degree of HBsAg decline at 48 weeks.