聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎优化策略初探  

A comparative study on the treatment efficiency of pegylated interferon α-2a in combination with adefovir dipivoxil in HBeAg positive chronic hepatitis B patients

作　　者：王亚东[1] 赵彩彦[1] 申川[1] 曹伟[1] 周俊英[1] 甄真[1] 刘芳[1] 阎文昭[1] 

机构地区：[1]河北医科大学第三医院感染科,石家庄050051

出　　处：《中国病毒病杂志》2011年第1期58-63,共6页Chinese Journal of Viral Diseases

摘　　要：目的探讨聚乙二醇干扰素α-2a(Peg-IFNα-2a)联合阿德福韦酯(ADV)治疗HBeAg阳性慢性乙型肝炎(CHB)的临床疗效及理想策略。方法 2005年1月至2009年12月纳入河北医科大学第三医院接受Peg-IFNα-2a治疗的HBeAg阳性CHB患者40例(A组),对HBV DNA≥1.0×107拷贝/ml或纤维化分期≥S3者(A1组,20例),初始联合ADV治疗;余者(A2组,20例)Peg-IFNα-2a初始单药治疗。24周复评HBV DNA、HBeAg、HBsAg定量,具备以下三项之一者:HBV DNA下降<2 lg拷贝/ml,HBeAg>100 S/CO,HBsAg下降<1 lg I U/ml,后续均Peg-IFNα-2a联合ADV治疗;余者Peg-IFNα-2a单药治疗。并遵循配对原则选择同期Peg-IFNα-2a(B组)、ADV(C组)单药治疗组各40例对照。于24周、48周、72周评估用药疗效、安全性、耐药和复发等。结果治疗24周,A1组患者HBV DNA下降值、抑制率、阴转率均优于A2组[(3.27±0.65)lg拷贝/mlvs(1.46±0.32)lg拷贝/ml,85%vs55%,75%vs40%,P<0.05];整体A、B组在HBV DNA下降值[(2.86±0.45)lg拷贝/mlvs(1.18±0.24)lg拷贝/ml]、抑制率(70%vs48%)、阴转率(58%vs30%),ALT复常率(80%vs58%)差异均有统计学意义(P<0.05)。治疗48周,A组HBeAg阴转率、转换率明显高于B组(68%vs45%,63%vs30%,P<0.05)和C组(68%vs33%,63%vs15%,P<0.01)。72周时,各组间差异趋势与治疗结束时一致,A组总体HBeAg阴转率、转换率略有上升,并新增2例HBsAg阴转患者。结论 Peg-IFNα-2a联合ADV治疗对血清、病毒学应答优于单药治疗,尤其结合基线特征以及HBV DNA、HBeAg、HBsAg变化,根据应答指导用药方案(RGT策略),其不失为CHB抗病毒优化治疗理想策略之一。Objective To explore the treatment efficiency of pegylated interferon α-2a（Peg-IFNα-2a） in combination with adefovir dipivoxil（ADV） in HBeAg positive chronic hepatitis B（CHB） patients.Methods Forty HBeAg positive CHB patients each were assigned to the combination treatment group of Peg-IFNα-2a and ADV（group A）,Peg-IFNα-2a only treatment group（group B） and ADV only treatment group（group C）.The patients of group A were further divided into two subgroups per HBV DNA load and liver fibrosis stage（A1：20 CHB patients with the HBV DNA≥1.0×107 copies/ml or the degree of liver fibrosis≥S3,A2： 20 CHB patients with the HBV DNA1.0×107 copies/ml and the degree of liver fibrosisS3）.The patients of subgroup A1 received the combination treatment,while those of subgroup A2 received Peg-IFNα-2a only for 24 weeks.All the patients of group A were reassessed and regrouped after 24 weeks according to treatment efficacy.Sixteen patients of group A then received the combination treatment for 24 weeks due to less than 102 copies/ml HBV DNA load decrease,or HBeAg quantification greater than 100 S/CO or less than 10 IU/ml decrease of HBsAg after the first 24 weeks of treatment simultaneously.The other 24 patients of group A received Peg-IFNα-2a only treatment for 24 weeks.The efficacy,safety and drug resistance of treatment were evaluated in week 24,48 and 72 after the initiation of treatment.Results After the first 24 weeks of treatment,the combination treatment（group A1）had better treatment efficiency in inhibiting HBV replication defined by the decreased copies,suppression rate（decreased≥2 lg copies/ml） and undetectable rate（500 copies/ml） of HBV DNA than the treatment with Peg-IFNα-2a only（A2）did[（3.27±0.65）lg copies/ml vs（1.46±0.32）lg copies/ml,85% vs 55%,75% vs 40% respectively,P0.05].The higher treatment efficiency was observed in decreasing copies of HBV DNA,increasing the HBV DNA suppression and undetectable rates as well as ALT normalization rate in the grou

关 键 词：肝炎 乙型 慢性 治疗 干扰素 阿德福韦酯 联合疗法 

分 类 号：R512.62[医药卫生—内科学]