恩替卡韦联合α-干扰素治疗慢性乙型肝炎患者疗效研究  

Virologic and biochemical response to entecavir and interferon-αcombination therapy in patients with chronic hepatitis B

作　　者：宋涛 徐敏 党子龙[3] 孙珺珺 Song Tao;Xu Min;Dang Zilong(Department of Pharmacy,People's Hospital,Qingyang 745000,Gansu Province,China)

机构地区：[1]庆阳市人民医院药剂科,甘肃省745000 [2]庆阳市人民医院消化内科,甘肃省745000 [3]兰州大学第一医院药剂科

出　　处：《实用肝脏病杂志》2023年第6期785-788,共4页Journal of Practical Hepatology

基　　金：甘肃省科技厅科研基金资助项目(编号:2021GH0312)。

摘　　要：目的探讨恩替卡韦联合α-干扰素(IFN-α)治疗慢性乙型肝炎(CHB)患者的疗效。方法2019年5月~2022年3月我院收治的69例CHB患者被随机分为A组35例和B组34例,分别给予恩替卡韦联合IFN-α或单纯恩替卡韦治疗,观察12个月。采用荧光定量PCR法检测血清HBV DNA载量,采用放射免疫分析法检测血清透明质酸(HA)、层粘连蛋白(LN)、IV型胶原(CIV)和III型前胶原(PIIIP)水平,采用ELISA法检测血清人尾肢同源蛋白2(Pygo2)、核转录因子κB(NF-κB)、转化生长因子-β(TGF-β)、肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平。结果在治疗6个月和12个月末,A组血清ALT复常率分别为88.6%和94.3%,显著高于B组的67.6%和73.5%(P<0.05),而两组血清HBV DNA阴转率无显著性差异(分别为91.4%对91.2,和97.1%对91.2%,P>0.05);在治疗12个月末,A组血清ALT和AST水平分别为(51.4±6.4)U/L和(47.5±5.2)U/L,显著低于B组【分别为(67.7±7.4)U/L和(61.9±6.7)U/L,P<0.05】;A组血清HA和PC-Ⅲ水平分别为(93.9±21.4)ng/mL和(87.3±15.8)ng/mL,显著低于B组【分别为(125.3±24.3)ng/mL和(108.9±14.7)ng/mL,P<0.05】;A组血清NF-kB、TGF-β和Pygo2水平分别为(1.1±0.3)pg/mL、(3.4±1.1)pg/mL和(41.9±4.6)μg/L,显著低于B组【分别为(1.6±0.4)pg/mL、(4.3±1.3)pg/mL和(54.6±5.2)μg/L,P<0.05】。结论应用恩替卡韦联合IFN-α治疗CHB患者较单用恩替卡韦治疗可以获得较好的短期疗效,提高肝功能指标复常率,降低血清肝纤维化指标,降低机体炎性反应,但联合短效IFN-α治疗对血清学应答的影响还需要观察。Objective This study was conducted to observe the virologic and biochemical response to entecavir and interferon-α(IFN-α)combination therapy in patients with chronic hepatitis B(CHB).Methods 69 patients with CHB were enrolled in our hospital between May 2019 and March 2022,and they were divided randomly into group A(n=35)and group B(n=34),receiving entecavir and FN-αcombination or entecavir alone therapy for 12 months.Serum HBV DNA loads were detected by fluorescence quantitative PCR,and serum hyaluronic acid(HA),laminin(LN),collagen IV(CIV)and procollagen III(PIIIP)levels were detected by radioimmunoassay.Serum human pygopus homolog 2(Pygo2),nuclear transcription factorκB(NF-κB),transforming growth factor-β(TGF-β),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels were detected by enzyme-linked immunosorbent assay.Results At the end of six and twelve month treatment,serum alanine aminotransferase(ALT)and aspartate aminotransferase(AST)normalization rates in group A were 88.6%and 94.3%,both significantly higher than 67.6%and 73.5%(P<0.05)in group B,while there was no significant difference as respect to serum HBV DNA loss(91.4%vs.91.2,and 97.1%vs.91.2%,respectively,P>0.05)between the two groups;at the end of twelve month treatment,serum ALT and AST levels in group A were(51.4±6.4)U/L and(47.5±5.2)U/L,significantly lower than[(67.7±7.4)U/L and(61.9±6.7)U/L,respectively,P<0.05]in group B;serum HA and PC-Ⅲlevels in group A were(93.9±21.4)ng/mL and(87.3±15.8)ng/mL,significantly lower than[(125.3±24.3)ng/mL and(108.9±14.7)ng/mL,respectively,P<0.05]in group B;serum NF-kB,TGF-βand Pygo2 levels in group A were(1.1±0.3)pg/mL,(3.4±1.1)pg/mL and(41.9±4.6)μg/L,all significantly lower than[(1.6±0.4)pg/mL,(4.3±1.3)pg/mL and(54.6±5.2)μg/L,respectively,P<0.05]in group B.Conclusion In clinical practice,the combination of entecavir and IFN-αtreatment in dealing with patients with CHB could alleviate liver function injury,decrease serum liver fibrosis index and reduce inflammatory reaction,and

关 键 词：慢性乙型肝炎 Α-干扰素 恩替卡韦 细胞因子 治疗 

分 类 号：R512.62[医药卫生—内科学]