聚乙二醇干扰素α-2a对乙型肝炎病毒复制及肝纤维化指标的影响  

Effect of peginterferonα-2a on hepatitis B virus replication and liver fibrosis indexes in patients with chronic hepatitis B

作　　者：田玉岭[1] 赵伟[1] 沈玲[1] 刘伟[1] 常家宝[1] 方之勋[1] 孙溪宾[1] 杨毅军[1] 杨永峰[1] 王爱芬[1] 

机构地区：[1]南京市第二医院肝病科,210003

出　　处：《中华传染病杂志》2007年第9期553-557,共5页Chinese Journal of Infectious Diseases

基　　金：南京市科技发展项目(宁科[2004]168号)

摘　　要：目的观察聚乙二醇干扰素α-2a对乙型肝炎患者病毒复制及肝纤维化的影响。方法治疗组30例HBeAg阳性慢性乙型肝炎患者予聚乙二醇干扰素α-2a 180μg皮下注射,每周1次,对照组12例患者予普通干扰素α-2a 500万U皮下注射,隔日1次,疗程均为48周,治疗结束后再随访72周。荧光定量PCR检测HBV DNA,放射免疫法检测血清肝纤维化指标。治疗组有9例患者治疗前、后行肝组织活检。结果治疗结束时至治疗结束后72周,治疗组HBeAg和HBV DNA定量值均显著低于对照组;治疗结束和治疗结束后72周时,治疗组血清HBeAg转阴及转换率、HBV DNA转阴率分别为58.6%、51.7%、48.3%和51.7%、14.8%、41.4%,均显著高于对照组。治疗组有3例血清HBsAg转阴,且持续到治疗结束后72周,对照组无转阴者。治疗组9例患者治疗前肝组织中HBsAg及HBcAg分别有8例和6例阳性,治疗结束时分别为2例和3例;治疗前、后肝组织炎症分级、纤维化分期及胶原表达差异无统计学意义(均P>0.05)。治疗结束时及结束后72周,治疗组血清HA、LN、ⅣC和Ⅲ型前胶原肽(PⅢP)较治疗前显著改善,在治疗结束后72周时均显著低于对照组。结论聚乙二醇干扰素α-2a能持久有效地抑制HBV复制,改善血清肝纤维化指标。Objective To evaluate the efficacy of peginterferon α-2a on viral suppression and anti-fibrosis in patients with chronic hepatitis B. Method The patients in treatment group（30 cases） were administered with peginterferon α-2a 180 μg subcutaneously, one time per week for 48 weeks. The patients in control group（42 eases） were administered with conventional interferon α-2a 5.0 MU subcutaneously, every other day for 48 weeks. All the patients were followed up for 72 weeks after discontinuation of the medication. The serum HBV DNA load was measured by quantitative polymerase chain reaction（PCR） assay. Serum liver fibrosis indexes were measured by radioimmunoassay. Nine patients in treatment group were performed liver biopsy before and after the treatment. Results At the end of treatment and the end of 72 week follow-up period, the serum HBeAg titer and HBV DNA level in treatment group were significantly lower than those in control group. The rates of HBeAg loss, seroeonversion and HBV DNA undeteetability were 58. 6%, 51. 7%, 48. 3% and 51.7%, 44.8% % 41.4%, respectively at the end of treatment and the end of 72-week follow-up period, which were significantly higher than those in control group. Three patients achieved HBsAg loss at the end of follow-up period, and none in control group. Eight and six patients of nine who were checked liver biopsy pathology in treatment group were HBsAg and HBcAg positive in liver tissue before treatment, respectively, and two and three were HBsAg and HBcAg positive after treatment, respectively. There were no differences of liver inflammation grade（G） fibrosis stages（S） and collagen expression after treatment（P〉 0.05）. At the end of treatment and 72-week follow-up period, the serum hexadecenoic acid（HA）, laminin（LN）, type P（collagen（ⅣC） and type Ⅲ pre collagen peptide（PⅢ P） levels of patients in treatment group were improved obviously, which were significantly lower than those in control group at the end of 72-week follow-up period.

关 键 词：肝炎 乙型 慢性 聚乙烯二醇类 干扰素Α 肝硬化 病毒复制 

分 类 号：R512.6[医药卫生—内科学]