干扰素治疗慢性乙型肝炎出现HBsAg/抗-HBs血清转换后病情复发  

Serum HBsAg repositive in patients with chronic hepatitis B after hepatitis B surface antigen seroconversion responsive to interferon-α therapy

作　　者：张黄醒[1] 张振华[1] 张礼周[1] 袁敏[1] 张亚飞[1] 苏倩[1] 李旭[1] 尹华发[1] 

机构地区：[1]安徽医科大学第一附属医院感染病科,合肥市230022

出　　处：《实用肝脏病杂志》2013年第2期128-130,共3页Journal of Practical Hepatology

基　　金：国家重大基础研究计划(973)项目(2009CB526411);高等学校博士学科点专项科研基金(20093420120005)

摘　　要：目的探讨干扰素治疗慢性乙型肝炎出现HBsAg血清转换后再转为阳性对病情的影响。方法 5例慢性乙型肝炎患者在使用干扰素治疗发生HBsAg血清转换,而后再现HBsAg阳性的病史特点、临床表现以及治疗过程中的肝功能、HBV DNA和HBeAg等变化情况。结果 5例患者接受干扰素治疗时间为3～15个月,在治疗开始后3～18个月发生HBsAg转阴;3例HBeAg阳性患者在HBsAg转阴之前或同时出现HBeAg转阴,但未发生HBeAg/抗HBe血清转换;5例患者HBsAb持续存在6～18个月后消失,且HBsAg在同时或之后复阳;1例患者在治疗后30个月时HBV DNA为3.36×106copies/ml,ALT为98u/L,开始接受替比夫定治疗;1例患者在干扰素治疗过程中发生白癜风。结论干扰素治疗慢性乙型肝炎患者出现HBsAg血清转换后再转为阳性可能与患者未出现HBeAg血清学转换、治疗时间不够长或肝内存在HBV cccDNA等有关。Objective To investigate the possible factors influencing serum HBsAg re-positivity in patients with chronic hepatitis B after hepatitis B surface antigen seroeonversion responsive to interferon-or therapy. Methods The clinical manifestations,liver function tests, HBV DNA and HBeAg in 5 patients with chronic hepati- tis B were observed during interferon-α treatment. Results The interferon regimen lasted for 3 to 15 months in this five patients,and the serum HBsAg clearance occurred in 3 to 18 months post-treatment;serum HBeAg posi- tive to negative without HBeAg/anti-HBe seroeonversion in three patients just before or at the same time HBsAg lost;serum HBsAb positive continued 6 to 18 months in this five eases, with the recurrence of HBsAg positive as anti-HBs disappeared;one patient had HBV DNA positive （3.36×10^6opies/ml） and ALT increased （98u/L）after 30 months of therapy who switched to telbivudine treatment;vitiligo occurred in one patient. Conclusion The recur- rence of HBsAg after HBsAg/anti-HBs seroconversion in interferon-treated patients with chronic hepatitis B might be related to HBeAg positive,inappropriate discontinuation of interferon therapy and existence of intrahepatic HBV cccDNA.

关 键 词：慢性乙型肝炎 干扰素 HBSAG 血清转换 复发 

分 类 号：R512.62[医药卫生—内科学]