聚乙二醇化干扰素α-2a对拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者的疗效  

Effect of peginterferon alfa-2a in treating lamivudine-resistant HBeAg-positive chronic hepatitis B

作　　者：马晓宇[1] 石小枫[1] 郭树华[1] 刘杞[1] 任红[1] 

机构地区：[1]重庆医科大学附属第二医院感染科,重庆400010

出　　处：《重庆医学》2013年第15期1717-1718,1721,共3页Chongqing medicine

摘　　要：目的探讨拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者,接受聚乙二醇化干扰素α-2a(PEGIFNα-2a)序贯治疗的临床疗效。方法对22例经拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者,在继续使用拉米夫定的情况下,加用PEGIFNα-2a180μg,每周1次,联用12周,然后停用拉米夫定,单用PEGIFNα-2a至48周,每月检查1次肝功能、血常规;每3个月检查乙型肝炎病毒(HBV)血清标志物及HBV DNA定量;治疗结束后随访48周。结果 HBV DNA基线平均表达水平为(6.54±0.90)copies/mL(log10)。在治疗结束后,有40.91%(9/22)的患者实现HBeAg血清转换和HBV DNA血清表达水平减少,13.64%(3/22)的患者实现HBsAg血清转换。随访48周,36.36%(8/22)的患者维持HBeAg血清转换和HBV DNA水平的降低,在维持HBeAg血清学转换的8例患者中,有2例患者持续维持HBsAg血清转换。结论 PEGIFNα-2a能部分明显降低拉米夫定治疗失败患者的HBV DNA水平,促进HBe Ag和HBs Ag的血清学转换。Objective To observe the clinical effect of pegylated interferon alfa-2a sequential therapy in the patients with lamivu- dine-resistant HBeAg-positive chronic hepatitis B（CHB）. Methods A total of 22 patients with lamivudine-resistant HBeAg-posi- tive chronic hepatitis were included in the study. Under the continuous use of lamivudine（100 mg,once daily）, all patients received peginterferon alfa-2a 180 g,once weekly for 12 weeks. Then lamivudine was discontinued and peginterferon alfa-2a as monotherapy was used till 48 weeks. Responses were measured once every 12 weeks after treatment,including HBsAg, HBeAg seroconversion and HBV DNA suppression. The liver function and blood routine test were examined once every 4 weeks. Results Mean HBV DNA level at baseline was （6.54±0.90）copies/mL（logl0）. At the end of treatment,40.91%（9/22） of the patients had HBeAg seroconversion and the decreased serum expression level of HBV DNA,and 13.640% （3/22） of the patients had HBsAg seroconver- sion,respectively. During 48-week follow up, the sustained HBeAg seroconversion and the decrease of HBV DNA level were a- chieved in 36.36 % （8/22） of the patients. Among 8 cases of the sustained HBeAg seroconversion, 2 cases sustained HBsAg sero- conversion. Conclusion Peginterferon alfa-2a can decrease the level of HBV DNA partially and obviously,and promote the HBeAg and HBsAg seroconversion in the patients with lamivudine-resistant HBeAg-positive CHB.

关 键 词：肝炎 乙型 慢性 聚乙烯二醇类 干扰素Α-2A 拉米夫定 治疗失败 

分 类 号：R512.62[医药卫生—内科学]