干扰素α-2b和阿德福韦酯治疗HBeAg阳性慢性乙型肝炎的疗效及影响因素分析

摘要

Objective To analyze the clinical effect and related factors of domestic interferon α-2b (IFNα-2b) and adefovir dipivoxil(ADV) in treatment for patients with chronic hepatitis B whose HBeAg is positive. Methods Ninety-two patients with chronic hepatitis B divided into observation group (n=46) and control group (n=46) according to different treatment methods. The observation group was taken orally ADV 10 mg,once a day, while the control group was treated with IFNα-2b five million units via subcutaneous or intramuscular injection,every other day. The course of treatment was 48 weeks. The alanine aminotransferase (ALT) and total bilirubin (TBIL) normalization rates, hepatitis B virus-DNA (HBV-DNA) and hepatitis B e antigen(HBeAg) negative rates, HBeAg conversion rate of serology indexes and incidence rate of adverse reactions were compared after treatment for 48 weeks in the two groups , the related factors were analyzed at meanwhile. Results After treatment for 48 weeks, the ALT and TBIL normalization rates and HBV-DNA negative rate of the observation group were significantly higher than those in the control group (χ2=17.94,10.74,17.18,P<0.05). The HBeAg negative conversion rate and HBeAg conversion rate of serology indexes between two groups were not statistically different(χ2=0.48, 0.02, P>0.05). Multivariate logistic regression analysis showed that ADV and higher baseline levels of aspartate amino transferase(AST) were independent forecasting factor of HBV-DNA negative rates(OR=412.52, 1.01, P<0.05) and ADV was independent forecasting factor of disappearance of HBeAg (OR=4.66, P<0.05). No case of ad-verse reactions was found in observation group. Conclusions The clinical effect and safety of ADV in treatment of patients with chronic hepatitis B is superior to those of domestic IFNα-2b. ADV and higher baseline levels of AST are independent forecasting factors of HBV-DNA negative rates. ADV is independent forecasting factor of disappearance of HBeAg.%目的：研究国产干扰素α-2b（IFNα-2b）和阿德福韦酯治疗乙型肝炎效果及疗效相关因素。方法选择92例慢性乙型肝炎按照治疗方法分为观察组和对照组各46例，观察组给予阿德福韦酯10 mg 口服，每日一次，对照组给予IFNα-2b 500万U皮下或肌肉注射，隔日一次，用药疗程均为48周。比较两组治疗48周后的谷丙转氨酶（ALT）复常率、总胆红素（TBIL）复常率、乙型肝炎病毒-DNA（HBV-DNA）转阴率、乙型肝炎 e 抗（ HBeAg）转阴率、HBeAg血清学转换率指标及不良反应发生情况，并分析影响疗效的相关因素。结果治疗48周观察组患者ALT、TBILI复常率及HBV-DNA转阴率均明显高于对照组，差异均有统计学意义（χ2分别=17.94、10.74、17.18，P均＜0.05）。观察组患者HBeAg转阴率和HBeAg血清学转换率与对照组比较，差异无统计学意义（χ2分别=0.48、0.02，P均＞0.05）。多因素logistic回归分析显示，阿德福韦酯及谷草转氨酶（AST）基线水平较高是HBV-DNA转阴的独立预测因素（OR分别=412.52、1.01，P均＜0.05），阿德福韦酯是HBeAg消失的独立预测因素（OR=4.66，P均＜0.05）。观察组患者耐受性较好，无1例发生不良反应。结论阿德福韦酯治疗慢性乙型肝炎在疗效及安全性等方面优于国产INFα-2b，并且阿德福韦酯及AST基线水平较高是HBV-DNA转阴的独立预测因素，阿德福韦酯是HBeAg消失的独立预测因素。