Peg-IFNα序贯联合NUCs治疗高病毒载量e抗原阳性乙型肝炎疗效观察

摘要

目的：探讨应答指导治疗（RGT）策略下聚乙二醇干扰素α与核苷类药物序贯联合治疗较单用聚乙二醇干扰素a治疗高病毒载量e抗原（HBeAg）阳性的慢性乙型肝炎患者的临床疗效与安全性。方法47例HBeAg阳性、乙型肝炎病毒（HBV）DNA>1×107IU/ml的慢性乙型肝炎患者应用聚乙二醇干扰素α抗病毒治疗12周后，根据患者HBV DNA下降是否>2lg IU/ml分为联合组和单药组：联合组加用一种核苷类药物，单药组为继续单用聚乙二醇干扰素α，两组均治疗至48周。观察两组治疗24周、48周的丙氨酸氨基转移酶（ALT）复常率、HBV DNA转阴率、血清HBeAg及HBsAg转阴/转换率。结果联合组24周及48周的HBV DNA不可检测率均高于单药组，但两组间差异均无统计学意义（P>0.05）；24周及48周联合组HBeAg和表面抗原（HBsAg）定量的下降幅度大于单药组。结论 RGT策略下聚乙二醇干扰素α应答不佳的高病毒载量HBeAg阳性慢性乙型肝炎患者序贯联合核苷（酸）类似物（NUCs）可以提高应答，但长期效果仍有待于进一步研究。%ObjectiveTo investigate the efficacy of Peg-interferon alphaα sequential combinated with Nucleos(t)ide analogues on HBeAg positive chronic hepatitis B patients with high serum hepatitis B viral loads compared with Peg-interferon alphaα alone under response-guided therapy. Methods47 CHB patients with HBeAg-positive and HBVDNA>1×107 IU/ ml used Peg-interferon alphaα antiretroviral therapy after 12 weeks, then divided them into joint group and monotherapy group according to HBV DNA decline is greater than 2 lg IU / ml or not:joint group received Peg-interferon alphaα combinated with one nucleoside drugs,monotherapy group continued to receive Peg-interferon alphaα alone,both groups were treated to 48 weeks. Observed boths groups of ALT normalization,HBV DNA negative rate,serum HBeAg and HBsAg negative/seroconversion rate after the treatment of 24weeks and 48 weeks.ResultsHBV DNA undetectable rate of 24weeks and 48weeks in joint group were higher than that of single treatment with Peg-IFN group(56.25% & 41.94%、93.75% & 70.97%),however the differences between them had no statistical significance (χ2=0.8685、3.2702,P>0.05); At 24 weeks and 48 weeks,the HBeAg and HBsAg quantitative decline extent of joint group were faster than that of monotherapy group.Conclusions Response can be improved under the strategy of response-guided therapy on high serum hepatitis B viral loads and HBeAg positive chronic hepatitis B patients who have poor response treat with Peg-interferon alphaα sequential combinated with Nucleos(t)ide analogues,but long-term effect remains to be further studied.