聚乙二醇干扰素α-2b联合替诺福韦二吡呋酯治疗HBeAg阳性慢性乙肝的临床效果

Clinical effect of peginterferonα-2 b combined with tenofovir dipivoxil in the treatment of HBeAg positive chronic hepatitis B

目的观察聚乙二醇干扰素α-2b联合替诺福韦二吡呋酯治疗乙肝e抗原(HBeAg)阳性慢性乙肝的临床效果。方法选取2019年1月—2023年1月厦门市第三医院收治的HBeAg阳性慢性乙肝患者80例,按随机数字表法分为联合组(n=40)和单药组(n=40)。单药组予替诺福韦二吡呋酯治疗,联合组在单药组基础上予聚乙二醇干扰素α-2b治疗,2组均持续治疗6个月。比较2组HBeAg及乙肝病毒脱氧核糖核酸(HBV-DNA)转阴率,治疗前后肝功能指标[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)]、血清炎性因子[肿瘤坏死因子-α(TNF-α)、白介素(IL)-6、IL-10]、肝纤维化指标[透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)]及不良反应。结果与单药组比较,联合组HBeAg及HBV-DNA转阴率均更高(χ^(2)=10.208,P=0.001;χ^(2)=4.507,P=0.034);与治疗前比较,治疗6个月后,2组AST、ALT、TBil、TNF-α、IL-6、IL-10、HA、PCⅢ、LN水平均降低,且联合组低于单药组(P<0.01)。联合组与单药组不良反应总发生率比较差异不明显(12.50%vs.7.50%,χ^(2)=0.139,P=0.709)。结论HBeAg阳性慢性乙肝患者应用聚乙二醇干扰素α-2b联合替诺福韦二吡呋酯治疗效果确切,有助于提高HBeAg、HBV-DNA转阴率,改善肝功能,减轻炎性反应及肝纤维化程度,且安全性较高。

Objective To observe the clinical effect of peginterferonα-2b combined with tenofovir dipivoxil in the treatment of HBeAg positive chronic hepatitis B.Methods Eighty patients with HBeAg positive chronic hepatitis B admitted to Xiamen Third Hospital from January 2019 to January 2023 were selected and randomly divided into the combination group(n=40)and the single drug group(n=40).The single drug group was treated with tenofovir dipivoxil,and the combination group was treated with peginterferonα-2b on the basis of the single drug group.Both groups were treated for 6 months.The negative conversion rates of HBeAg and HBV-DNA,liver function indexes(AST,ALT,TBil),serum inflammatory factors(TNF-α,IL-6,IL-10),liver fibrosis indexes(HA,PCⅢ,LN)before and after treatment,and adverse reactions were compared between the two groups.Results Compared with the single drug group,the negative conversion rates of HBeAg and HBV-DNA in the combination group were higher(χ^(2)=10.208,P=0.001/χ^(2)=4.507,P=0.034).Compared with before treatment,the levels of AST,ALT,TBil,TNF-α,IL-6,IL-10,HA,PCⅢand LN in the two groups were decreased after 6 months of treatment,and the levels in the combination group were lower than those in the single drug group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the combination group and the single drug group(12.50%vs.7.50%,χ^(2)=0.139,P=0.709).Conclusion The effect of peginterferonα-2b combined with tenofovir dipivoxil in the treatment of HBeAg positive chronic hepatitis B patients is accurate,which is helpful to improve the negative conversion rates of HBeAg and HBV-DNA,improve liver function,reduce inflammatory reaction and liver fibrosis,and has high safety.