聚乙二醇干扰素α-2a 治疗新疆地区不同 HBV基因分型乙肝患者的临床疗效

摘要

目的：探讨聚乙二醇干扰素α-2a 治疗新疆地区不同 HBV 基因分型乙型肝炎（乙肝）患者的临床疗效。方法选择56例符合纳入和排除标准的慢性乙型肝炎患者，均采用聚乙二醇干扰素α-2a 抗病毒治疗，疗程为6个月。检测所有患者的基因型，并对不同基因型患者乙肝表面抗原（HBsAg）、乙肝 e 抗原（HBeAg）、血清 HBeAg定量、乙肝病毒基因（HBV-DNA）定量、谷丙转氨酶（ALT）、HBsAg 阴转率、HBeAg 阴转率、血清 HBeAg 转换率、HBV-DNA 阴转率以及 ALT 复常率进行比较。结果18例 HBeAg 阳性患者中 HBsAg 阴转2例，血清 HBeAg转换4例，血清学转换率为22．22％；56例患者 HBV 基因型以 C 型为主，共36例，其余为 B 型，C 型患者 HBV-DNA 显著高于 B 型，差异有统计学意义（P ＜0．05）；随着治疗时间的延长，两组患者的 HBV-DNA 阴转率以及ALT 复常率成显著升高趋势，差异有统计学意义（P ＜0．05），HBsAg 阴转率、HBeAg 阴转率以及血清 HBeAg 转换率无明显改变（P ＞0．05），且相同时间点 B 型和 C 型患者上述指标差异均无统计学意义（P ＞0．05）；与治疗前比较，治疗后两组 HBsAg 定量均无明显差异，2种基因型相同时间点 HBsAg 定量比较差异无统计学意义（P ＞0．05）。结论新疆地区乙肝患者聚乙二醇干扰素α-2a 抗病毒治疗 HBsAg 阴转率降低，应答情况不理想，疗效欠佳，且基因型对疗效无明显影响。%Objective The aims of this study were to investigate the effects of different genotypes of hepati-tis B virus to PEG-INF-α-2a in Xinjiang.Methods A total of 56 patients with chronic hepatitis B were de-termined,according to the integration and elimination stan-dard.After 6-month peg-interferon alfa-2a anti-viral treatmen,all patients were analyzed according to their HBsAg/anti-HBs profile,HBeAg/anti-HBe profile,viral load,and Alanine aminotransferase (ALT)serum level.Results There were 2 patients who have HBsAg seroclearance,and 4 patients who have hepatitis B antigen (HBeAg)seroconversion in 18 pa-tients with HBeAg-positive chronic hepatitis B.The conversion rate is 22.22%.There were 36 patients whose genotype identified was C in 56 individuals,and the rests were B.Patients infected by genotype C HBV also have a better response than those infected by genotype B HBV (P <0.05);With the extension of peg-interferon treat ment,patients infected by genotype C HBV also have a better response than those infected by genotype B HBV on viral load and alanine aminotransferase serum level (P <0.05).However, The HBsAg seroclearance and HBeAg seroconversion have not response to peg-interferon treatment (P >0.05).And the same point of time in patients with type B and C above indicators had no significant differ-ence (P >0.05).Compared with before treatment,after treatment in the two groups were no significant differences of HBsAg quantitative,two genotypes of the same point in time HBsAg quantitative compari-son difference also has no statistical significance (P >0.05).Conclusion Based on the results of this stud-y,we find HBsAg level is not a useful on-treatment monitoring tool to predict the response to peg-interfer-on alfa-2a,and the genotypes of hepatitis B virus is not good enough as a marker to guide patient selection for peg-interferon treatment in Xinjiang.