目的：观察干扰素α-1b (IFNα-1b)联合替比夫定序贯治疗乙型肝炎的疗效，并探讨其对患者血清中可溶性程序性死亡蛋白1(sPD-1)和可溶性可诱导共刺激分子(sICOS)水平的影响。方法选取我院2012年1月至2013年5月符合条件的患者80例，按随机数表法随机分为观察组和对照组，每组40例。两组患者均给予IFNα-1b治疗，50 g/次，隔日1次，肌内注射。对照组继续给予IFNα-1b巩固治疗，用量同前，疗程12个月。观察组口服替比夫定序贯治疗，600 mg/次，1次/d，疗程12个月。比较两组患者治疗后的应答有效率以及治疗前后的血清sPD-1和sICOS水平，检测两组患者的门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及γ-谷氨酸酰基转移酶(GGT)，并参照慢性肝病量表(CLDQ)评价生活质量。结果观察组患者的完全应答率和部分应答率分别为50.0%(20/40)和37.5%(15/40)，均高于对照组的40.0%(16/40)和25.0%(10/40)，差异均有统计学意义(P<0.05)；观察组患者治疗后的CLDQ量表各项评分均明显高于对照组，差异均有显著统计学意义(P<0.01)；观察组治疗后AST [(26.56±2.85) U/L]、ALT [(30.28±3.23) U/L]和GGT [(34.26±3.58) U/L]水平均显著低于对照组(P<0.01)；观察组治疗后血清中sPD-1和sICOS水平分别为(404.27±41.26) pg/mL和(35.78±3.91) pg/mL，均明显低于对照组的(517.91±52.55) pg/mL和(44.36±4.56) pg/mL，差异均有显著统计学意义(P<0.01)。结论 IFNα-1b联合替比夫定序贯治疗乙型肝炎可明显改善患者生活质量，提高应答总有效率，其抑制患者血清中sPD-1和sICOS水平表达可能在治疗中发挥重要作用。%Objective To observe the clinical efficacy of ordinary interferon alpha-1b (IFNα-1b) combined with telbivudine in sequentially treating patients with chronic hepatitis B and its effect on serum soluble apoptosis pro-tein 1 (sPD-1) and soluble inducible costimulatory molecule (sICOS). Methods According to the random number ta-ble method, a total of 80 eligible cases, who admitted to our hospital from January 2012 to May 2013, were randomly di-vided into control group and treatment group, with 40 cases in each group. Patients in both groups received IFNα-1b by intramuscular injection once every two days (50 g each time). The control group was given consolidation therapy of IFNα-1b for 12 months; The treatment group was given telbivudine in sequential treatment for 12 months (600 mg each time). Response rates after treatment were compared and serum sPD-1 and sICOS were detected in both groups before and after treatment. Indexes of liver function aspartate aminotransferase (AST), alanine aminotransferase (ALT), andγ-glutamyl transpeptidase (GGT) were measured in two groups. Life treatment evaluations in both groups were com-pared according to Chronic Liver Disease Questionnaire (CLDQ). Results Complete response rate [50.0%(20/40)] and part response rate [37.5% (15/40)] in treatment group were higher than those in control one [40.0% (16/40), 25.0%(10/40), respectively] with statistical difference (χ2=4.418, P<0.05). After treatment, scores of CLDQ in treatment group were evidently higher than control one (P<0.01);Levels of AST [(26.56±2.85) U/L], ALT [(30.28±3.23) U/L], and GGT [(34.26 ± 3.58) U/L] in the treatment group were significantly lower than those in control group after treatment (P<0.01). After treatment, levels of serum sPD-1 [(404.27 ± 41.26) pg/mL] and sICOS [(35.78 ± 3.91) pg/mL] in the treatment group were obviously lower than control group [(517.91 ± 52.55) pg/mL, (44.36 ± 4.56) pg/mL, respectively] with statistical difference (P<0.01). Conclusion Ordinary interferon combined with telbivudine in sequentially treat-ing patients with chronic hepatitis B could notably improve patients' life quality and increase the response efficient rates. Its role may be related to suppressing the levels of sPD-1 and sICOS in serum.
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