HBsAg定量监测指导干扰素治疗HBeAg阴性慢性乙型肝炎研究  

Directive value of serum HBsAg quantification for interferon treatment in patients with HBeAg-negative chronic hepatitis B

作　　者：谭淑燕[1] 邹敏超[1] 上官辉[2] 

机构地区：[1]佛山市第二人民医院感染科,广东佛山528000 [2]佛山市第二人民医院血液内科,广东佛山528000

出　　处：《广州医科大学学报》2014年第4期65-68,共4页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨HBsAg定量监测对干扰素个体化治疗HBeAg阴性慢性乙型肝炎的指导作用。方法:2010年11月至2013年11月本院就诊的62例HBeAg阴性慢性乙型肝炎患者,采用α-2b干扰素500万IU,皮下注射,隔日1次治疗。抗病毒治疗至24周时根据HBsAg定量下降情况进行分组。HBsAg定量下降≥1 lg IU/mL的患者纳入A组,HBsAg定量下降<1 lg IU/mL的患者随机分成B1组和B2组。A组和B1组继续给予α-2b干扰素治疗,B2组加用阿德福韦酯治疗,疗程共48周。所有患者随访24周。结果:A、B1和B2组的持续病毒学应答率分别为88.2%,22.7%和59.1%。A组和B2组持续病毒学应答率比较,差异无统计学意义,且明显高于B1组。随访24周时A、B1和B2组HBV DNA较基线下降幅度分别为[(5.00±1.62)、(2.70±1.52)和(4.13±2.00)]lg copies/mL,B2组HBV DNA较基线下降幅度与A组接近,明显大于B1组。A组患者HBsAg平均下降幅度高于B1组和B2组,最终A组有2例(11.8%)HBsAg消失,B1和B2组均为0。结论:HBsAg水平变化与HBeAg阴性慢性乙型肝炎患者抗病毒治疗持续应答相关。干扰素治疗24周时HBsAg下降≥1 lg IU/mL的患者持续病毒学应答率显著高于HBsAg下降<1 lg IU/mL的患者,对干扰素治疗24周时HBsAg下降<1 lg IU/mL患者可联合阿德福韦酯以提高持续病毒学应答率。Objective：To explore the directive value of serum HBsAg quantification for individualized interferon treatment in patients with HBeAg-negative chronic hepatitis B. Methods： 62 patients with HBeAg-negative CHB admitted in our hospital from November 2010 to November 2013 were given IFNα-2b 5MIU, and injected subcutaneously every other day. Till the 24 th week of antiviral therapy, they were divided into groups basing on the decrease condition of HBsAg quantification. Then, patients showing a decrease of serum HBsAg level ≥1lg IU/mL were included into group A. Other patients showing a decrease of serum HBsAg level〈1lg IU/mL were divided into B1 and B2 groups randomLy. Patients in group A and B1 went on being treated by IFNα-2b. Patients in group B2 were given adefovir dipivoxil on the basic treatment. And the course of treatment was 48 weeks. All subjects were followed up for 24 weeks. Results： Rates of sustained virological response （ SVR） for groups A, B1 and B2 were 88.2%,22.7% and 59.1% respectively. SVR rate for group B1 was the lowest, and there was no significant difference between group A and B2. On the 24th week of follow-up, HBV DNA decline levels of groups A, B1 and B2 were 5.00±1.62, 2.70±1.52 and 4.13±2.00 lg copies/mL respectively. HBV DNA decline level of group B2 was close to group A, and was greater than group B1. The mean decline in serum HBsAg level of group A was greater than group B1 and group B2. HBsAg of 2 cases （11.8%） lost in group A, while none of patents in group B1 or B2 got HBsAg loss.Conclusion：The change in serum HBsAg level is related to continuous response of the antiviral therapy in patients with HBeAg-negative chronic hepatitis B. SVR rates of those patients showing a decrease of serum HBsAg level≥1lg IU/mL in week 24 will be higher than the patients showing a decrease of serum HBsAg level〈1lg IU/mL. If patients show a decrease of serum HBsAg level〈1lg IU/mL in week 24 of interferon treatment, combining with adefovir dipivoxil is suggested to increase

关 键 词：肝炎 乙型  慢性 肝炎表面抗原  乙型 干扰素Α-2B 

分 类 号：R512.6[医药卫生—内科学]