46例核苷(酸)类似物应答不佳的慢性乙肝患者予序贯干扰素α-2b治疗的临床观察  

Sequential Interferon Alpha-2b Therapy in 46 Chronic Hepatitis B Patients with Poor Nucleoside Analog Response

作　　者：向海鸿 吴志国 宋淑芬 龙林 艾茂兴 刘翠芸[1] 谢琼 杨龙 孙水林[1] XIANG Hai-hong;WU Zhi-guo;SONG Shu-fen;LONG Lin;AI Mao-xing;LIU Cui-yun;XIE Qiong;YANG Long;SUN Shui-lin(Department of Infectious Diseases,the Second Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Infection,Huangshi Central Hospital(Affiliated Hospital of Hubei Institute of Technology)Huangshi 435000,China)

机构地区：[1]南昌大学第二附属医院感染科,南昌330006 [2]黄石市中心医院(湖北理工学院附属医院)感染科,湖北黄石435000

出　　处：《南昌大学学报（医学版）》2024年第3期11-15,共5页Journal of Nanchang University：Medical Sciences

基　　金：江西省科技厅科技计划支撑项目(20151BBG70164)。

摘　　要：目的 探讨经核苷(酸)类似物(NAs)治疗的慢性乙型肝炎(CHB)患者,接受序贯IFN α-2b治疗的效果,为NAs经治且应答不佳的CHB患者抗病毒治疗提供参考。方法 经NAs治疗的46例CHB患者中,NAs耐药者31例(N1组),NAs部分病毒学应答者15例(N2组),均接受序贯IFN α-2b重叠NAs治疗12~24周后停用NAs,仅予序贯IFN α-2b治疗。收集2组患者乙肝五项[乙肝表面抗原(HBsAg)、乙肝表面抗体(HBsAb)、乙肝e抗原(HBeAg)、乙肝e抗体(HBeAb)、乙肝核心抗体(HBcAb)]、乙肝DNA定量(HBV-DNA)等相关指标,并于治疗第12、24和48周(T1、T2和T3)时进行比较。结果 N1组因严重失眠脱落1例。N1组和N2组患者HBV-DNA定量在T1、T2和T3治疗时间节点均明显低于其基线值(P<0.05),但2组治疗时间节点间HBV-DNA定量比较差异无统计学意义(P>0.05)。N1组和N2组各治疗时间节点病毒学应答率(T1:53.3%和40.0%;T2:60.0%和47.0%;T3:50.0%和53.0%),HBsAg阴转率(T1:6.6%和0.0%;T2:10.0%和0.0%;T3:13.3%和0.0%),HBeAg阴转率(T1:17.4%和0.0%;T2:26.0%和0.0%;T3:26.0%和36.4%)和HBeAg血清学转换率(T1:0.0%和0.0%;T2:4.3%和0.0%;T3:4.3%和18.2%)比较,差异均无统计学意义(P>0.05)。治疗期间均未出现严重不良反应,停用NAs后未出现肝衰竭等不良事件。结论 NAs部分病毒学应答及NAs耐药CHB患者,IFNα-2b序贯治疗后均可取得较好的效果,安全性均良好。此类患者治疗期间可实现NAs的停用,且可作为临床优化抗病毒治疗的方案之一。Objective To investigate the efficacy of sequential IFNα-2b therapy in patients with chronic hepatitis B(CHB)treated with nucleoside(acid)analogs(NAs),and to provide clinical reference for antiviral therapy in CHB patients with poor response to NAs.Methods Of 46 patients with CHB treated with NAs,31 patients with NAs resistance were established as the N1 group and 15 patients with partial virologic response to NAs were categorized as the N2 group;both groups received sequential IFNα-2b overlapping NAs for 12 to 24 weeks,and then discontinued NAs and were given sequential IFNα-2b therapy only.Patients'hepatitis B pentameters[hepatitis B surface antigen(HBsAg),hepatitis B surface antibody(HBsAb),hepatitis B e antigen(HBeAg),hepatitis B e antibody(HBeAb),and hepatitis B core antibody(HBcAb)]and hepatitis B DNA quantification(HBV-DNA)were collected.The relevant indexes at the 12th,24th and 48th weeks(T1,T2 and T3)were compared between the 2 groups.Results One case was shed in Group N1 due to severe insomnia.The HBV-DNA quantifications of patients in Groups N1 and N2 were significantly lower than their baseline values at the T1,T2 and T3 treatment time points(P<0.05),but the difference in the HBV-DNA quantifications was not statistically significant in the 2 groups(P>0.05).Virologic response rates in Groups N1 and N2(T1:53.3%and 40.0%;T2:60.0%and 47.0%;T3:50.0%and 53.0%),HBsAg-negative rates(T1:6.6%and 0.0%;T2:10.0%and 0.0%;T3:13.3%and 0.0%),HBeAg-negative rates(T1:17.4%and 0.0%;T2:26.0%and 0.0%;T3:26.0%and 36.4%)and HBeAg serologic conversion rates(T1:0.0%and 0.0%;T2:4.3%and 0.0%;T3:4.3%and 18.2%)were not statistically significant when compared at each time point(P>0.05).None of them experienced serious adverse effects during treatment,and no adverse events such as liver failure occurred after discontinuation of NAs.Conclusion IFNα-2b sequential therapy can have positive clinical outcomes,achieving discontinuation of NAs and showing favorable safety profile,and it can be considered as one of the optimal antiviral

关 键 词：慢性乙型肝炎 核苷(酸)类似物 干扰素 疗效 安全 

分 类 号：R512.62[医药卫生—内科学]