目的 探讨24周未能有效抑制HBV DNA复制的聚乙二醇干扰素α-2a治疗病例,加用阿德福韦酯(ADV)是否能增加HBV慢性感染者HBeAg血清转换和HBV DNA抑制率(≤1×10~3拷贝/ml).方法 聚乙二醇干扰素α-2a治疗的57例HBeAg阳性慢性乙肝患者在第24周时进行HBVDNA荧光定量PCR检测,若HBV DNA>1×10~3拷贝/ml,则加用ADV(A组,21例)或不加用ADV(B组,14例)治疗;若≤1×10~3拷贝/ml,则继续聚乙二醇干扰素α-2a治疗(C组,22例),对比分析在治疗48周时的HBeAg血清转换率、ALT复常率和HBV DNA抑制率的差别.结果 治疗至第48周时,A、B、C三组的HBeAg血清转换率分别为23.8%、28.6%和63.6%(A vs C,P=0.014),ALT复常率和HBV DNA抑制率的差异无统计学意义.在治疗24～48周期间,A、B两组HBeAg血清转换率、ALT复常率和HBV DNA抑制率差异无统计学意义,但A组HBV DNA下降幅度高于B组(2.60±1.37 vs 0.86±2.09,P=0.005).结论 在聚乙二醇干扰素α-2a治疗第24周未能实现HBV DNA显著抑制时,加用阿德福韦酯联合治疗能明显增加对HBV DNA复制的抑制效果.%Objective To investigate whether the combination therapy of pegylated IFNα-2a plus adefovir dipivoxil (ADV) improve the efficacy of the treatment in CHB patients with HBeAg positive or not. Methods 57 CHB patients with HBeAg positive received 48-week pegylated IFNα-2a therapy were enrolled into this study. If serum HBV DNA levels exceeded 1000 copies/ml at week 24, the patients were assigned to group A (pegylated IFN-α2a plus ADV, 21 cases) or group B (pegylated IFNα-2a only, 14 cases);otherwise, they received the unceasing monotherapy of pegylated IFNα-2a (group C, 22 cases). Results At week 48, HBeAg seroconversion rates were 23.8% , 28.6% and 63.6% (A vs C,P=0.014), but rates of aminotransferases normalization and HBV DNA suppression (< 1000 copies/ml) were not statistically significant among three groups. But during week 24 to week 48, rates of HBeAg seroconversion, aminotransferases normalization and HBV DNA suppression were also not statistically significant between group A and B. But amplitude of DNA drop in group A was much more than that in group B (2.60±1.37 vs 0.86±2.09, P=0.005). Conclusion An ADV add-on therapy in pegylated IFNα-2a treatment seems able to improve the inhibition of HBV DNA in chronic hepatitis B patients with HBeAg positive. It requires a large, double-blind, randomized clinical trial to further provent.
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