核苷(酸)类似物治疗慢性乙型肝炎部分应答后加用α干扰素继续治疗疗效分析

摘要

Objective To evaluate the serological response of interferon-alpha-1b (INF-α-1b)boasting regimen after virological response to nucleoside analogue treatment in patients with chronic hepatitis B (CHB).Methods 71 patients with HBeAg-positive CHB were selected,and they had had HBV DNA loss and alanine aminotransferase (ALT)normalization,but had had not HBeAg negativity to nucleoside analogue treatment.Thirtyeight patients were treated with nucleoside analogues they always received and INF-α-lb,while 33 patients continued nucleoside analogues for 48 weeks.Results At the end of 36 weeks of treatment,the negative rate of serum HBeAg in combination group was significantly higher than that in nucleoside group (36.8％ vs.15.2％,P=0.039);At 48 weeks,the negative rate of serum HBeAg (42.1％)and HBeAg/anti-HBe seroconversion rate (36.8％) were significantly higher in the former group than those (18.2％ and 15.2％,respectively,P=0.030 and 0.039) in the latter;There were no ALT and HBV DNA fluctuation and obvious adverse reactions in the two groups.Conclusion IFN-α might rescue the nucleoside analogues therapy to improve HBeAg/anti-HBe seroconversion rate.%目的 比较核苷(酸)类似物(NA)治疗慢性乙型肝炎(CHB)部分应答后加用α-干扰素组与未加用干扰素组的疗效.方法 筛选出71例经NA抗病毒治疗后出现HBV DNA转阴,ALT复常半年以上,但持续未出现HBeAg血清转换的HBeAg阳性CHB患者,随机分为联合干扰素组(n=38例)和单用NA组(n=33例),观察治疗4、12、24、36和48周两组患者HBeAg阴转率、HBeAg血清转换率、生化及HBV DNA水平的变化.结果 在治疗36周时,联合组HBeAg阴转率为36.8％,高于单用NA组的15.2％(P=0.039)；在治疗48周时,联合组HBeAg阴转率和HBeAg血清转换率分别为42.1％和36.8％,明显高于单用NA组的18.2％和15.2％(P=0.030和0.039)；治疗过程中两组均未出现ALT、HBV DNA波动及明显的不良反应.结论 干扰素可辅助NA治疗,提高患者HBeAg血清转换率,是一种有效的治疗方法.