聚乙二醇干扰素α-2a联合阿德福韦酯对HBeAg阳性慢性乙肝患者细胞免疫功能影响

Effect of peginterferon α-2a combined with adefovir dipivoxil on cellular immune function of patients with HBe Ag-positived chronic hepatitis B

目的探讨聚乙二醇干扰素α-2a联合阿德福韦酯对乙型肝炎E抗原(HBe Ag)阳性慢性乙型肝炎(CHB)患者细胞免疫功能影响。方法选取鹤壁市传染病医院2010年1月—2013年1月收治的200例HBe Ag阳性CHB患者,随机分为观察组和对照组,每组100例。观察组采用聚乙二醇干扰素α-2a联合短程阿德福韦酯治疗,对照组采用拉米夫定加阿德福韦酯治疗,观察两组治疗6个月前后临床疗效、免疫功能、肝功能、安全性与不良反应发生率。结果观察组谷丙转氨酶(ALT)正常化率、HBe Ag转阴率或转换率和乙肝病毒脱氧核糖核酸(HBV-DNA)转阴率均明显高于对照组,差异有统计学意义(P<0.05);观察组患者治疗结束及随访6个月时血清干扰素-γ(IFN-γ)、白细胞介素-2(IL-2)水平均明显高于治疗前,且观察组均明显高于对照组,差异均有统计学意义(P<0.05);观察组患者治疗后阳性辅助性T淋巴细胞(CD4)、抑制性/细胞毒性T淋巴细胞(CD4/CD8)升高,与治疗前比较差异有统计学意义(P<0.05),且组间比较差异亦有统计学意义(P<0.05);观察组患者治疗后ALT、谷草转氨酶(AST)、直接胆红素水平均明显低于治疗前,组间差异亦有统计学意义(P<0.05或P<0.01)。两组患者用药安全性与不良反应发生率比较,差异无统计学意义(P>0.05)。结论聚乙二醇干扰素α-2a联合短程阿德福韦酯治疗HBe Ag阳性CHB临床效果显著,能够促进T淋巴细胞的增殖、分化、成熟和分泌功能,提高体内IFN-γ、IL-2水平,激活免疫。

Objective To investigate the effect of peginterferon alfa-2a combined with adefovir dipivoxil on cellular immune function of patients with HBe Ag-positived chronic hepatitis B(CHB). Methods Totally 200 cases of patients with HBe Ag-positived CHB hospitalized in Infectious Disease Hospital of Hebi from January 2010 to January 2013 were enrolled and then were randomly divided into observation group and control group, each 100. Observation group received peginterferon alfa-2a combined with short-range adefovir dipivoxil, but control group received lamivudine plus adefovir dipivoxil. Clinical efficacy, immune function, liver function, safety and incidence of adverse reactions were observed after treatment for 6 months. Results The ALT normalization rate, HBe Ag negative conversion rate or HBV-DNA negative conversion rate in the observation group were significantly higher than those in the control group, the difference was significant(all P<0.05). The serum levels of IL-2 and IFN-γwere significantly higher in observation group on the end of treatment or 6 months after treatment than those before treatment and those in control group(all P<0.05). There were significant differences on CD4 and CD4/CD8 of the observation group before treatment and after treatment, and the difference was found between observation group and control group(P<0.05). The levels of ALT, AST in observation group were lower after treatment than those before treatment, and the difference was also significant between the observation group and the control group(P<0.05 or <0.01). The drug safety and adverse reactions of the two groups had no significant difference(all P>0.05). Conclusion The peginterferon alfa-2a combined with adefovir dipivoxil has a significant effect on patients with HBe Agpositived CHB. It can promote the proliferation, differentiation, maturation and secretion of T lymphocytes and raise the levels of IFN-7, IL-2, activate the immune function.