不同用药方案治疗HBeAg阳性慢性乙型肝炎的效果及对血清IFN-γ、IL-10的影响

摘要

Objective To investigate the effect of different therapeutic regimen in the treatment of HBeAg-positive chronic hepatitis B (CHB) and the influence on the levels of serum interferon-γ (IFN-γ) and interleukin-10 (IL-10),so as to analyze the change rules of immune cytokines and its significance.Methods The patients with HBeAg-positive CHB admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from June 2011 to June 2013 were selected as research objects,and they were randomly divided into single pegylated interferon alpha-2a group (group A),single Adefovir Dipivoxil group (group B) and combined treatment group (group C) by random number table method,with 30 cases in each group.The clinical curative effect,the changes of serum IFN-γ IL-10 and the ratio of IFN-γ/IL-10 were compared and analyzed,and the resistance in the process of treatment was recorded.Results After treatment for 48 weeks,the proportion of virologic response [hepatitis B virus DNA (HBV DNA) ≤500 copies/mL] of group C was significantly higher than that of group A and group B,the differences were all statistically significant (P ＜ 0.05).The serological conversion rate of HBeAg in group C was obviously higher than that of group B,the difference was highly statistically significant (P ＜ 0.01).The serum IFN-γ level and IFN-γ/IL-10 ratio of the three groups were all highly significantly higher than those before treatment (P ＜ 0.01).At 24 weeks follow-up after drug withdrawal,the proportion of virologic response and the serological conversion rate of HBeAg in group C were significantly higher than those of group B,the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).The levels of serum IFN-γand IL-10 in group C were obviously lower than those at the time of drug withdrawal,and the serum IFN-γ level and IFN-γ/ IL-10 ratio were significantly lower than those of group A and B,the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusion Pegylated interferon alpha-2a combined with Adefovir Dipivoxil in the treatment of HBeAgpositive CHB can further increase the virologic response rate and serological response rate,speed up the recovery of Th1,Th2 immune balance,which is worthy of clinical promotion.%目的 探讨不同用药方案治疗HBeAg阳性慢性乙型肝炎(CHB)的效果及对血清γ干扰素(IFN-γy)、白介素-10(IL-10)水平的影响,分析免疫细胞因子变化规律及意义.方法 选择2011年6月～2013年6月新疆维吾尔自治区人民医院收治的HBeAg阳性CHB患者为研究对象,采用随机数字表法将其分为聚乙二醇干扰素α-2a单药组(A组)、阿德福韦酯单药组(B组)和联合治疗组(C组),各30例.对比分析三组临床疗效及血清IFN-γ、IL-10水平、IFN-γy/IL-10比值变化,同时记录治疗过程中的耐药情况.结果 治疗48周时,C组病毒学应答[乙型肝炎病毒DNA(HBV DNA)≤500拷贝/mL]所占比例均明显高于A组和B组,差异均有统计学意义(P＜0.05);C组HBeAg血清学转换率明显高于B组,差异有高度统计学意义(P＜0.01);三组血清IFN-γ水平和IFN-γ/IL-10比值明显高于治疗前,差异有高度统计学意义(P＜0.01).停药后24周随访时,C组病毒学应答所占比例及HBeAg血清学转换率均明显高于B组,差异均有统计学意义(P＜ 0.05或P＜0.01);C组血清IFN-γ、IL-10水平均较停药时明显降低,而血清IL-1O水平、IFN-γ/IL-10比值均明显低于A组和B组,差异均有统计学意义(P＜ 0.05或P＜ 0.01).结论 聚乙二醇干扰素α-2a与阿德福韦酯联合治疗HBeAg阳性CHB能进一步提高病毒学应答率和血清学应答率,加快机体Th1、Th2免疫平衡恢复,值得临床推广.