聚乙二醇干扰素联合替诺福韦治疗乙型与丙型肝炎病毒双重感染的疗效  

Efficacy of pegylated interferon alpha-2a combined with tenofovir in treatment of hepatitis B virus/hepatitis C virus co-infection

作　　者：李双 李颖[2] 谢菲 Li Shuang;Li Ying;Xie Fei(Department of Pharmacy,Xidian Group Hospital,Xi’an 710077,China;Endoscopy Center,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]西电集团医院药剂科,西安710077 [2]陕西省人民医院腔镜中心,西安710068

出　　处：《中国药物应用与监测》2024年第6期738-742,共5页Chinese Journal of Drug Application and Monitoring

基　　金：陕西省中医药管理局科研项目(SZY-NLTL-2022-020)

摘　　要：目的探讨聚乙二醇干扰素α-2a(PEG-IFNα-2a)联合替诺福韦治疗乙型肝炎病毒(HBV)/丙型肝炎病毒(HCV)双重感染的疗效及作用机制。方法选取2022年7月至12月西电集团医院收治的HBV/HCV双重感染患者122例,采用随机数字表法分为单药组(仅应用PEG-IFNα-2a)与联合组(给予PEG-IFNα-2a与替诺福韦联合治疗)各61例,比较两组病毒学应答率、肝功能指标、肝纤维化指标、氧化应激与免疫指标。结果联合组HBV完全病毒学应答率(78.69%)、HCV治疗结束病毒学应答率(93.44%)高于单药组(57.38%、77.05%)(P<0.05);治疗后联合组肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)[分别是(33.27±8.95)U·L^(-1)、(31.47±11.45)U·L^(-1)、(14.47±3.55)μmol·L^(-1)],均低于单药组[分别是(45.91±12.64)U·L^(-1)、(40.57±12.58)U·L^(-1)、(19.84±3.25)μmol·L^(-1)],差异有统计学意义(P<0.05);治疗后联合组肝纤维化指标透明质酸(HA)、Ⅳ型胶原(Ⅳ-C)、Ⅲ型前胶原(PCⅢ)、层黏蛋白(LN)[分别是(115.24±25.92)μg·L^(-1)、(51.85±15.27)ng·mL^(-1)、(97.85±12.55)μg·L^(-1)、(68.82±18.38)ng·mL^(-1)],均低于单药组[分别是(194.25±21.48)μg·L^(-1)、(69.27±14.69)ng·mL^(-1)、(114.72±16.92)μg·L^(-1)、(81.46±17.46)ng·mL^(-1)],差异有统计学意义(均P<0.05);治疗后联合组氧化应激指标丙二醛(MDA)、一氧化氮(NO)[分别是(5.38±2.38)nmol·L^(-1)、(52.72±13.27)ng·L^(-1)],低于单药组[分别是(9.44±3.04)nmol·L^(-1)、(71.47±15.82)ng·L^(-1)],差异有统计学意义(均P<0.05);治疗后联合组免疫指标调节性T细胞(Treg)、Treg/辅助性T细胞17(Th17)[分别是(5.23±0.34)%、(4.03±0.25)]低于单药组[分别是(5.78±0.29)%、(4.47±0.32)],差异有统计学意义(均P<0.05)。结论PEG-IFNα-2a联合替诺福韦治疗HBV/HCV双重感染可提高病毒清除效果,保护肝功能,改善肝纤维化,其作用机制可能与抑制氧化应激与免疫调节有关。Objective To investigate the efficacy and mechanism of pegylated interferonα-2a(PEG-IFNα-2a)combined with tenofovir in the treatment of hepatitis B virus(HBV)/Hepatitis C virus(HCV)co-infection.Methods A total of 122 patients with HBV/HCV co-infection treated in Shaanxi Provincial People’s Hospital from July to December 2022 were selected as the research subjects and divided into the monotherapy group(PEG-IFN-α-2a only)and combined group(PEG-IFN-α-2a combined with tenofovir)by using the random number table method,with 61 in each group.Virological response rate,liver function index,liver fibrosis index,oxidative stress index and immune index were compared between the two groups.Results The HBV complete virological response rate and HCV completion virological response rate were significantly higher in the combined group than in the monotherapy group(78.69%vs 57.38%,93.44%vs 77.05%)(P<0.05).After treatment,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)were(33.27±8.95)U·L^(-1),(31.47±11.45)U·L^(-1),(14.47±3.55)μmol·L^(-1),in the combined group.They were all lower than those of(45.91±12.64)U·L^(-1),(40.57±12.58)U·L^(-1),(19.84±3.25)μmol·L^(-1)in the monotherapy group and the differences were statistically significant(P<0.05).As for liver fibrosis indexes,the levels of hyaluronic acid(HA),typeⅣcollagen(Ⅳ-C),typeⅢprocollagen(PCⅢ)and laminin(LN)were(115.24±25.92)μg·L^(-1),(51.85±15.27)ng·mL^(-1),(97.85±12.55)μg·L^(-1)and(68.82±18.38)ng·mL^(-1)in the combined group.They were all lower than those of(194.25±21.48)μg·L^(-1),(69.27±14.69)ng·mL^(-1),(114.72±16.92)μg·L^(-1)and(81.46±17.46)ng·mL^(-1)in the monotherapy group and the differences were statistically significant(P<0.05).For the oxidative stress indexes,the levels of MAD and NO were(5.38±2.38)nmol·L^(-1)and(52.72±13.27)ng·L^(-1)in the combination group and they were lower than those of(9.44±3.04)nmol·L^(-1)and(71.47±15.82)ng·L^(-1)in the monotherapy group,show

关 键 词：聚乙二醇干扰素Α-2A 替诺福韦 肝炎 肝功能 氧化应激 免疫 

分 类 号：R512.62[医药卫生—内科学] R512.63[医药卫生—临床医学]