[1]李长安,赵巍峰,刘淑媛,等.核苷类似物序贯联合聚乙二醇干扰素α-2b治疗乙型肝炎表面抗原低水平慢性乙型肝炎患者疗效观察[J].新乡医学院学报,2022,39(4):323-329.[doi:10.7683/xxyxyxb.2022.04.005]
　LI Changan,ZHAO Weifeng,LIU Shuyuan,et al.Effect of sequential combination of nucleoside analogues and pegylated interferon α-2b in the treatment of chronic hepatitis B patients with low level of hepatitis B surface antigen[J].Journal of Xinxiang Medical University,2022,39(4):323-329.[doi:10.7683/xxyxyxb.2022.04.005]
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核苷类似物序贯联合聚乙二醇干扰素α-2b治疗乙型肝炎表面抗原低水平慢性乙型肝炎患者疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年4
页码:
323-329
栏目:
临床研究
出版日期:
2022-04-05

文章信息/Info

Title:
Effect of sequential combination of nucleoside analogues and pegylated interferon α-2b in the treatment of chronic hepatitis B patients with low level of hepatitis B surface antigen
作者:
李长安; 赵巍峰; 刘淑媛; 窦　芊; 杜敬佩; 杨　瑞; 王园园; 李　赢
（新乡医学院第三附属医院感染性疾病科，河南　新乡　453003）
Author(s):
LI Chang′an; ZHAO Weifeng; LIU Shuyuan; DOU Qian; DU Jingpei; YANG Rui; WANG Yuanyuan; LI Ying
(Department of Infectious Disease,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)
关键词:
慢性乙型肝炎; 核苷类似物; 聚乙二醇干扰素; 乙肝表面抗原; 乙型肝炎病毒; 序贯治疗
Keywords:
chronic hepatitis B; nucleoside analog; pegylated interferon; hepatitis B surface antigen; hepatitis B virus; sequential therapy
分类号:
R512.6+2
DOI:
10.7683/xxyxyxb.2022.04.005
文献标志码:
A
摘要:
目的　探讨核苷类似物（NA）恩替卡韦序贯联合聚乙二醇干扰素α-2b（PEG-IFNα-2b）治疗乙型肝炎表面抗原（HBsAg）低水平慢性乙型肝炎（CHB）患者的临床效果。方法　选择2018年8月至2019年8月新乡医学院第三附属医院收治的60例HBsAg低水平CHB患者为研究对象，采用简单随机分组法将患者分为观察组和对照组，每组30例。对照组患者继续给予恩替卡韦治疗48周，观察组患者先给予恩替卡韦和PEG-IFNα-2b联合治疗12周，再给予PEG-IFNα-2b单药治疗36周。治疗后48周评估2组患者的临床疗效。分别于治疗前及治疗12、24、48周和治疗后24、48周检测2组患者血清HBsAg、乙型肝炎e抗原(HbeAg)、乙型肝炎病毒（HBV）DNA、天冬氨酸氨基转移酶（AST）和丙氨酸转移酶（ALT）水平，并计算血清HBsAg和HBeAg阴转率。结果　治疗后48周，观察组和对照组患者治疗总有效率分别为76.67%（23/30）、43.33%（13/30），观察组患者治疗总有效率显著高于对照组（P<0.05）。治疗前2组患者血清HBsAg、HBeAg、ALT和AST水平比较差异无统计学意义（P>0.05）；治疗后2组患者血清HBsAg、HBeAg、ALT和AST水平整体呈下降趋势（P<0.05）；治疗12、24、48周及治疗后24、48周，观察组患者血清HBsAg水平显著低于对照组（P<0.05）；治疗24、48周及治疗后24、48周，观察组患者血清HBeAg、ALT水平显著低于对照组（P<0.05）；治疗48周及治疗后24、48周，观察组患者血清AST水平显著低于对照组（P<0.05）。治疗24周时2组患者血清HBsAg阴转率比较差异无统计学意义（P>0.05）；治疗48周及治疗后24、48周时，观察组患者血清HBsAg阴转率显著高于对照组（P<0.05）；治疗12、24、48周及治疗后24、48周时，观察组患者血清HBeAg阴转率显著高于对照组（P<0.05）。治疗前2组患者血清HBV DNA水平比较差异无统计学意义（P>0.05），2组患者治疗12周至治疗后48周时血清HBV DNA水平显著低于治疗前（P<0.05）；治疗12、24、48周及治疗后24、48周，观察组患者血清HBV DNA水平显著低于对照组（P<0.05）；治疗后24、48周（停药后），2组患者血清HBV DNA水平有上升趋势。结论　NA序贯PEG-IFN联合治疗NA治疗后HBsAg低水平CHB患者具有良好的临床疗效，可有效抑制HBV DNA复制，提高血清HBsAg和HBeAg的阴转率。
Abstract:
Objective　To investigate the clinical effect of sequential combination of nucleoside analogues(NA) entecavir and pegylated interferon α-2b (PEG-IFNα-2b) in the treatment of chronic hepatitis B(CHB) patients with low level of hepatitis B surface antigen(HBsAg).Methods　A total of 60 CHB patients with low level of HBsAg admitted to the Third Affiliated Hospital of Xinxiang Medical University from August 2018 to August 2019 were selected as the research subject,and the patients were divided into observation group and control group by simple random grouping method,with 30 cases in each group.The patients in the control group were treated with entecavir for 48 weeks.The patients in the observation group were treated with entecavir and PEG-IFNα-2b for 12 weeks,and then treated with PEG-IFNα-2b for 36 weeks.The clinical effect of patients in the two groups was evaluated at 48 weeks after treatment.The levels of serum HBsAg,hepatitis B e antigen (HBeAg),hepatitis B virus (HBV) DNA,aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were detected at pretherapy and 12,24,48 weeks of treatment and 24,48 weeks after treatment.The negative conversion rate of HBsAg and HBeAg was calculated.Results　At 48 weeks after treatment,the total effective rate of patients in the observation group and control group was 76.67% (23/30) and 43.33% (13/30),respectively.The total effective rate of patients in the observation group was significantly higher than that in the control group (P<0.05).There was no significant difference in the levels of serum HBsAg,HBeAg,ALT and AST between the two groups before treatment (P>0.05).The levels of serum HBsAg,HBeAg,ALT and AST of patients in the two groups showed a downtrend after treatment (P<0.05).The level of serum HBsAg of patients in the observation group was significantly lower than that in the control group at 12,24 and 48 weeks of treatment and 24 and 48 weeks after treatment (P<0.05).The levels of serum HBeAg and ALT of patients in the observation group were significantly lower than those in the control group at 24 and 48 weeks of treatment and 24 and 48 weeks after treatment (P<0.05).The level of serum AST of patients in the observation group was significantly lower than that in the control group at 48 weeks of treatment and 24 and 48 weeks after treatment (P<0.05).There was no significant difference in the negative conversion rate of serum HbsAg between the two groups at 24 weeks of treatment (P>0.05),but the negative conversion rate of serum HBsAg in the observation group was significantly higher than that in the control group at 48 weeks of treatment and 24 and 48 weeks after treatment (P<0.05).At 12,24,48 weeks of treatment and 24,48 weeks after treatment,the negative conversion rate of serum HBeAg in the observation group was significantly higher than that in the control group (P<0.05).There was no significant difference in serum HBV DNA level between the two groups before treatment (P>0.05).The level of serum HBV DNA from 12 weeks of treatment to 48 weeks after treatment was significantly lower than that before treatment in the two groups (P<0.05).The level of serum HBV DNA of patients in the observation group was significantly lower than that in the control group at 12,24,48 weeks of treatment and 24,48 weeks after treatment (P<0.05).The level of serum HBV DNA of patients in the two groups showed an upward trend at 24 and 48 weeks after treatment (after drug withdrawal).Conclusion　The sequential combination of Na and PEG-IFNα-2b in the treatment of CHB patients with low level of HBsAg after Na treatment has a good clinical effect,which can effectively inhibit HBV DNA replication and improve the negative conversion rate of serum HBsAg and HBeAg.

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更新日期/Last Update: 2022-04-05