不同转换治疗策略对经治的低病毒血症慢性乙型肝炎患者疗效的影响:单中心回顾性研究  

Different switching therapy for chronic hepatitis B patients with low-level viraemia:a single-center retrospective study

作　　者：王玉珊 孔银[1] 刘元元[1] 刘天府[1] 麻爱娣 张亚萍[1] 李永芳[1] 张岭漪[1] Wang Yushan;Kong Yin;Liu Yuanyuan(Department of Liver Diseases,Second Hospital,Lanzhou University,Lanzhou 730000,Gansu Province,China)

机构地区：[1]兰州大学第二医院肝病科,兰州市730000

出　　处：《实用肝脏病杂志》2022年第5期633-636,共4页Journal of Practical Hepatology

基　　金：甘肃省自然科学基金资助项目(编号:21JR1RA146);兰州大学第二医院“萃英科技创新”计划项目(编号:CY2018-BJ17/CY2021-QN-A18)。

摘　　要：目的探讨不同转换治疗策略对慢性乙型肝炎(CHB)经治发生低病毒血症(LLV)患者疗效的影响。方法本研究纳入197例ETV或TDF经治的发生LLV的CHB患者,被分为A组74例,B组63例和C组60例,分别给予ETV或TDF单药维持治疗或TAF替换治疗或ETV或TDF联合长效干扰素(peg-IFN)α-2b治疗观察48周。结果在48周治疗末,C组完全病毒学应答率(CVR)和HBeAg阴转率分别为90.0%和41.7%,显著高于A组的16.2%和5.4%(P<0.05)或B组的66.7%和9.5%(P<0.05),B组和C组血清ALT复常率分别为20.6%和23.3%,显著高于A组的8.1%(P<0.05);C组血清HBsAg水平为3.0(2.8,3.4)lgIU/ml,显著低于A组【3.3(2.9,3.9)lgIU/ml,P<0.05】或B组【3.4(3.3,3.8)lgIU/ml,P<0.05】,血清HBeAg水平为0.1(-0.7,0.0)lgIU/ml,显著低于A组【0.6(-0.6,1.8)lgIU/ml,P<0.05】或B组【0.6(-0.3,1.8)lgIU/ml,P<0.05】,血清HBV DNA水平为1.3(1.3,1.3)lgIU/ml,显著低于A组【1.7(1.3,2.0)lgIU/ml,P<0.05】或B组【1.6(1.3,1.4)lgIU/ml,P<0.05】;B组和C组肝脏硬度检测(LSM)分别为6.4(4.3,8.4)kPa和6.2(4.2,7.7)kPa,显著低于A组【8.6(5.2,10.7)kPa,P<0.05】,三组血清ALT水平比较,无统计学差异(P>0.05)。结论对于核苷类经治出现LLV的CHB患者,为保险起见,换用TAF或继续核苷类联合peg-IFNα-2b治疗可进一步获得较好的病毒学应答率和一定程度的血清学应答率,其对长期疾病转归的影响还需要观察。Objective The aim of this study was to investigate the efficacy of switching from entecavir(ETV)or tenofovir(TDF)to other different antiviral therapy in ETV-or TDF-treated chronic hepatitis B(CHB)patients with low-level viraemia(LLV).Methods A total of 197 patients with CHB who had been treated with ETV or TDF were enrolled in this study and were divided into group A(n=74)continuing ETV or TDF treatment,group B(n=63)switching to TAF therapy and group C(n=60)switching to ETV or TDF and peg-IFNα-2b combination therapy.The regimen lasted for(48±2)weeks.Results At the end of 48 week treatment,the complete virologic response and serum HBeAg negative rates in group C were 90.0%and 41.7%,significantly higher than 16.2%and 5.4%(P<0.05)in group A or 66.7%and 9.5%(P<0.05)in group B,and serum ALT normalization rates in group B and group C were 20.6%and 23.3%,significantly higher than 8.1%(P<0.05)in group A;serum HBsAg level in group C was 3.0(2.8,3.4)lgIU/ml,significantly lower than[3.3(2.9,3.9)lgIU/ml,P<0.05]in group A or[3.4(3.3,3.8)lgIU/ml,P<0.05]in group B,serum HBeAg level was 0.1(-0.7,0.0)lgIU/ml,significantly lower than[0.6(-0.6,1.8)lgIU/ml,P<0.05]in group A or[0.6(-0.3,1.8)lgIU/ml,P<0.05]in group B,and serum HBV DNA load was 1.3(1.3,1.3)lgIU/ml,significantly lower than[1.7(1.3,2.0)lgIU/ml,P<0.05]in group A or[1.6(1.3,1.4)lgIU/ml,P<0.05]in group B;the LSMs in group B and group C were 6.4(4.3,8.4)kPa and 6.2(4.2,7.7)kPa,both significantly lower than[8.6(5.2,10.7)kPa,P<0.05]in group A,and serum ALT levels in the three groups were not significantly different(P>0.05).Conclusion The switch to TAF or combined with peg-IFNα-2b therapy in ETV-or TDF-treated patients with LLV might benefit for further virologic and even serologic response,and warrants clinical investigation.

关 键 词：慢性乙型肝炎 低病毒血症 富马酸丙酚替诺福韦 聚乙二醇干扰素Α-2B 转换治疗 

分 类 号：R512.62[医药卫生—内科学]