干扰素α佐甘露聚糖肽治疗基因B型和C型慢性乙型肝炎  

Alpha interferon and mannatide combined therapy for genotypes B and C chronic hepatitis B patients

作　　者：伍林柏 胡金华[2] 倪辉 程书权 

机构地区：[1]桂林市卫生监督所,广西桂林540001 [2]桂林医学院研究生院,广西桂林541004 [3]桂林市第三人民医院肝病科,广西桂林541002

出　　处：《中国病毒病杂志》2012年第2期133-137,共5页Chinese Journal of Viral Diseases

基　　金：广西壮族自治区卫生厅立项课题(Z2008241)

摘　　要：目的探讨干扰素α联合甘露聚糖肽治疗乙型肝炎(乙肝)e抗原(HBeAg)阳性的基因B、C型慢性乙型肝炎(CHB)的临床效果。方法随机将80例门诊和住院的HBeAg阳性CHB患者分为治疗组和对照组各40例,治疗组基因B型28例,基因C型12例;对照组基因B型26例,基因C型13例。治疗组用干扰素α-2b500万U/次皮下注射,疗程52周;联合甘露聚糖肽10 mg/d静脉滴注,4周后改为2.5mg/d肌内注射,12周为1个疗程,共2～3个疗程。对照组单用干扰素α-2b。两组分别于治疗前、治疗后2、4、8、16、26、52周检查肝功能、乙肝5项血清标志物、HBV DNA定量、血常规等,记录不良反应。结果 52周时,HBeAg转阴率、HBeAg转换率和HBV DNA转阴率治疗组均明显高于对照组(52.5%vs 27.5%,P<0.05;30.0%vs 7.5%,P<0.01;47.5%%vs 22.5%,P<0.05)。ALT复常率和HBeAg转阴率基因B型患者均明显高于基因C型患者(83.3%vs 52.0%,P<0.01;51.9%vs16.0%,P<0.01)。基因B型患者HBeAg转阴率、HBeAg转换率和HBV DNA转阴率治疗组均明显高于对照组(67.9%vs 34.6%;35.7%vs 7.7%;57.1%vs 23.1%;P均<0.01)。停药52周后复查,HBeAg转阴率、HBeAg转换率和HBV DNA转阴率治疗组较停药时均有不同程度的提升,仍均明显高于对照组。治疗组白细胞减少的绝对数和恢复速度均优于对照组。结论联合治疗可显著提高CHB患者的ALT复常率和HBeAg阴转率,促进HBeAg的血清学转换和HBV DNA清除,对抗干扰素α导致的外周血白细胞减少,增加患者的治疗依从性。治疗效果基因B型患者优于C型。Objective To evaluate the efficacy of a-interferon combined with mannan peptide in the treatment of chronic hepatitis B patients. Methods Eighty outpatients and inpatients with HBeAg positive chronic hepatitis B were randomly divided into two groups with 40 in each. One group was treated daily with subcuta- neous injection of interferon a-2b （5 000 000 IU） for a 52-week course, combined with daily intravenous injec- tion of mannan peptide （10 mg per injection） for the first 4 weeks and following 12 weeks of daily intramuscu lar injection （2.5 mg per injection） as one course; each patient in this group was undergone 2-3 courses of the combined treatment. The 40 patients in the other group were treated with interferon a-2b only. HBV genotype was determined by restriction fragment length polymorphism （RFLP）. Indicators for liver function and serum markers for HBV infection, HBV-DNA quantization, and other clinical data were examined and recorded before and at 2, 4, 8, 16, 26, and 52-weeks after treatment. Results After 52 weeks of treatment, theserum alanine aminotransferase （ALT） normalization rate, and the negative conversion rates of HBsAg, HBeAg, and HBV-DNA in the combined treatment group were significantly higher than that in the control group. Twenty-eight genotype B and 12 genotype C HBV infection were identified in the combined treatment group, and 26 genotype B and 13 genotype C were found in the control group. Stratified analysis indicated that the ALT normalization rate, and the negative conversion rates of HBsAg, HBeAg, and HBV DNA in patients of genotype B were obviously higher than that of genotype C. The incidence of leukopenia was lower in the combined treatment group and the recovery of leucopenia in the combined treatment group was faster than that in the control group. Conclusions Combined administration of mannan peptide and s-interferon significantly enhanced the efficacy of HBeAg-positive chronic hepatitis B patients when comparing with patients who accepted only a-interfer

关 键 词：肝炎 乙型 慢性 肝炎e抗原 乙型 甘露聚糖肽 干扰素Α 

分 类 号：R512.62[医药卫生—内科学]