干扰素提高低水平HBsAg慢性乙型肝炎患者临床治愈率的分析  

Interferon increases clinical cure rate in chronic hepatitis B patients with low HBsAg levels

作　　者：邓樱[1] 刘明[1] 郭艳[1] 向小梅[1] 谭朝霞[1] 毛青[1] 

机构地区：[1]第三军医大学西南医院全军感染病研究所,感染病研究重庆市重点实验室,重庆400038

出　　处：《第三军医大学学报》2016年第18期2053-2059,共7页Journal of Third Military Medical University

基　　金：国家重点基础研究发展计划(973计划;2013CB531501);第三军医大学临床科研重大专项(2012XLC05)~~

摘　　要：目的明确干扰素(interferon,IFN)治疗低水平HBs Ag慢性乙型肝炎患者的临床治愈率、影响因素及最适疗程。方法回顾性分析了2012年1月至2014年8月间在我院感染科门诊接受聚乙二醇干扰素(Peg-IFN)或普通干扰素治疗疗程≥24周、HBs Ag<3 000 IU/m L的慢性乙型肝炎患者74例,获得HBs Ag和HBe Ag清除定义为应答,治疗第24、48、72周依次分析疗效影响因素,采用非参数检验、χ2检验、Logistic回归模型分析应答组与未应答组患者的一般情况、HBV标志物以及治疗过程中各指标变化对HBs Ag清除的影响。结果 74例患者治疗至停药时,25例(33.8%)发生应答,应答组中位基线HBs Ag水平较不应答组低(70.70 IU/m L vs 440.71 IU/m L,P=0.041);Peg-IFN的HBs Ag清除率高于普通IFN(41.9%vs 22.6%,P=0.084)。第12周HBs Ag下降百分数可预测24周疗效(OR=1.058,P=0.010),ROC曲线下面积为0.860,Cut-off值为78.9,敏感性为0.889,特异性为0.815。基线HBV DNA水平和第24周HBs Ag下降百分数可预测48周疗效(OR=9.116,P=0.033;OR=1.089,P=0.006),第24周HBs Ag下降百分数ROC曲线下面积0.870,最佳的Cut-off值为69.7,敏感性为1,特异性为0.722。48周内清除率与治疗时间呈线性正相关,至48周时HBs Ag清除21例,占总应答例数的84.0%(21/25)。结论 IFN治疗基线HBs Ag<3 000 IU/m L病例的临床治愈率明显高于基线水平高者,Peg-IFN略优于普通IFN,疗程建议为48周,治疗12周后可根据当前时间点的HBs Ag下降程度评估后续疗效。Objective To investigate the clinical cure rate, influencing factors and optimal duration of interferon （IFN） treatment on chronic hepatitis B （CHB） patients with low HBsAg levels. Methods A total of 74 CHB patients with low HBsAg levels （ HBsAg 〈 3 000 IU/mL） who received pegylated or conventional IFN treatment for at least 24 weeks in our department from January 2012 to August 2014 were enrolled in this retrospective study. The patients were divided into response group, partial response group and non-response group depending on the serum status of HBsAg and HBeAg at 24, 48 and 72 weeks. Non- parametric test, Chi-square test and logistic regression analysis were used to comparatively study the baseline, HBV serum markers and other laboratory parameters between the response and non-response groups during the treatment. Results Twenty-five of 74 patients （33.8%） responded to the treatment till the drug withdrawal. The median baseline level of HBsAg in response group was lower than that of the non-response group （70.70 vs 440.71 IU/mL, P = 0. 041 ）. Pegylated IFN （Peg-IFN） had conventional IFN （41.9% vs 22. 6% , P =0. 084）. The decreased a better effect on HBsAg clearance than percentage of HBsAg quantitation at week 12 could predict the treatment efficacy at week 24 （ OR = 1. 058 ,P =0. 010）. The area under the ROC curve was 0.860, cut-off value was 78.9, sensitivity was 0. 889 and specificity was 0. 815. Similarly, baseline level of HBV DNA and the decreased percentage of HBsAg quantitation at week 24 could predict the treatment efficacy at week 48 （OR = 9. 112 ,P = 0. 033 ;OR = 1. 089, P = 0.006）. The area under the ROC curve was 0.870, cut-off value was 69.7, sensitivity was 1 and specificity was 0. 722. There was a positive liner relationship between HBsAg clearance rate and treatment duration within 48 weeks. Twenty-one of the 74 （28.4%） patients achieved response at week 48, which accounted for 84.0 % （21/25） of the total response patients at the end of treatment

关 键 词：干扰素 乙型肝炎表面抗原 慢性乙型肝炎 临床治愈 

分 类 号：R181.23[医药卫生—流行病学] R512.62[医药卫生—公共卫生与预防医学]