肝脂肪变对慢性乙型肝炎患者聚乙二醇干扰素α治疗临床疗效的影响  

Impact of liver steatosis on antiviral effects of pegylated interferon-alpha in patients with chronic hepatitis B

作　　者：施军平[1] 陆璐[2] 钱建成[2] 昂健[3] 荀运浩[1] 过建春[1] 石伟珍[1] 王宇芳[1] 范建高[4] 

机构地区：[1]杭州市第六人民医院,310014 [2]浙江中医药大学 [3]浙江大学医学院附属第二医院 [4]上海交通大学医学院附属新华医院

出　　处：《中华肝脏病杂志》2012年第4期285-288,共4页Chinese Journal of Hepatology

基　　金：上海市科委“创新行动计划”（09140903500）;国家重点基础研究发展计划（973计划,2012CB517501）;浙江省自然科学基金（Y2091200）

摘　　要：目的探讨肝脂肪变对聚乙二醇干扰素α（Peg-IFNα）治疗慢性乙型肝炎（CHB）患者临床疗效的影响。方法96例HBeAg阳性CHB初治患者，经肝活组织检查证实合并肝脂肪变者34例（肝脂肪变组）、无肝脂肪变者62例（无肝脂肪变组），均用Peg-IFNα治疗，疗程为48周，比较两组患者治疗结束时病毒学应答和生化学应答的差异。每组均数差异的比较采用t检验，率的比较采用，检验。结果HBV DNA滴度肝脂肪变组患者为（6．96±1．27）lg10拷贝／ml，无肝脂肪变组患者为（7．54±1．28）lg10拷贝／ml，两组比较，t=2．161，P=0．033，差异有统计学意义。Peg-IFNα治疗48周时，HBeAg转换率、HBV DNA阴转率在肝脂肪变组分别为35．2％（12／34）和44．1％（15／34）；无肝脂肪变组分别为38．7％（24／62）和48．3％（30／62），两组比较，差异无统计学意义。完全应答率在肝脂肪变组为26．5％，无肝脂肪变组为48．4％，两组比较，Х^2=4．373，P=0．037，差异有统计学意义。在45例HBVDNA转阴患者中，7例无生化学应答，其中肝脂肪变组有5例，无肝脂肪变组2例，无生化应答率肝脂肪变组显著高于无肝脂肪变组，P=0．032，差异有统计学意义。结论CHB患者合并肝脂肪变不影响Peg-IFNα治疗48周时病毒学应答，但可能会影响其生化学应答。Objective To investigate the impact of hepatic steatosis on virologic response in chronic hepatitis B （CHB） patients treated with pegylated interferon-alpha （PEG-IFNa）. Methods Ninety-six naive patients postive for hepatitis B e antigen （HBeAg） and with biopsy-proven CHB were administered PEG-IFNa-2a or PEG-IFNa-2b for 48 weeks. Virologic response （HBeAg clearance and hepatitis B virus （HBV） DNA 〈 5 log10 copies/ml） and biochemical response （alanine transaminase （ALT） normalization） were compared between patients with （n = 34） and without （n =62） steatosis. Results The HBV DNA titer in the stcatosis group was significantly lower than that of the non-steatosis group （6.961.27 vs. 7.541.28 log10 copies/ml; t= 2.161,P= 0.033）. After 48 weeks of PEG-IFNa treatements, there was no significant difference in HBeAg undeteetable HBV DNA （〈 3 log10 copies/ml） between s teatosis and non-steatosis patients. However, the steatosis patients presented with a significantly lower complete response rate （virologic response plus biochemical response） compared to non-steatosis patients （26.5% vs. 48.4%; Х^2 = 4.373, P = 0.037）. Of the 45 CHB patients with undetectable HBV DNA after 48 weeks of treatment, seven did not achieve ALT normalization. The rate of patients with non-biochemical response was significantly higher in the steatosis group than in the non-steatosis group （33.3% vs. 6.67%; P = 0.032）. Conclusions Hepatic steatosis does not affect the virologic response, but does affect the biochemical response in CHB patients treated with PEG-IFNa for 48 weeks.

关 键 词：肝炎 乙型 慢性 脂肪肝  治疗 干扰素Α 

分 类 号：R512.62[医药卫生—内科学]