中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2011年
3期
182-185
,共4页
李明慧%谢尧%路遥%邱国华%刘凤%李杏红%赵辉%宋淑静%关小平%成军%徐道振
李明慧%謝堯%路遙%邱國華%劉鳳%李杏紅%趙輝%宋淑靜%關小平%成軍%徐道振
리명혜%사요%로요%구국화%류봉%리행홍%조휘%송숙정%관소평%성군%서도진
肝炎,乙型,慢性%干扰素α-2a%治疗%肝炎表面抗原,乙型%肝炎病毒,乙型
肝炎,乙型,慢性%榦擾素α-2a%治療%肝炎錶麵抗原,乙型%肝炎病毒,乙型
간염,을형,만성%간우소α-2a%치료%간염표면항원,을형%간염병독,을형
Hepatitis B,chronic%Interferon alfa-2a%Therapy%Hepatitis B surface antigens%Hepatitis B virus
目的 探讨延长聚乙二醇干扰素α-2a疗程对慢性乙型肝炎患者获得HBsAg消失/血清学转换的影响.方法将217例慢性乙型肝炎患者根据体质量分为＜60 kg和≥60 kg两组,分别皮下注射聚乙二醇干扰素α-2a 135μg或180 μg,治疗过程中根据患者外周血中性粒细胞数和血小板数调整药物剂量.每3个月采用酶免疫化学发光法定量检测HBsAg/抗-HBs、HBeAg/抗-HBe,HBV DNA采用实时荧光定量聚合酶链式反应检测,将治疗时间＞12周的患者纳入统计分析,在治疗过程中,对HBV DNA、HBsAg含量降低的患者,HBeAg含量下降的HBeAg阳性患者,治疗48周后HBsAg含量＜200 IU/ml患者进行延长治疗,经意向性分析治疗患者HBsAg血清学转换发生率.采用x2检验进行统计学分析.结果 217例慢性乙型肝炎患者,治疗时间为12.0～197.6周,平均(53.1±33.4)周,其中118例患者治疗时间≥48周,89例治疗时间＜48周.13.4%(29/217)的患者获得HBsAg消失/HBsAg血清学转换,其治疗时间为17.6～197.6周,平均(75.4±42.8)周,其中治疗时间＞48周24例(82.8%),小于48周5例(17.2%);HBV DNA平均转阴时间为(20.8±8.9)周.148例HBeAg阳性患者中,9.5%(14/148)的患者获得HBsAg消失/血清学转换,在获得HBsAg消失/血清学转换的患者中,治疗时间均＞48周(54～194周),平均(81.3±39.4)周.21.7%(15/69)的HBeAg阴性患者获得HBsAg消失/血清学转换,与HBeAg阳性患者的HBsAg消失/血清学转换率(9.5%)比较,x2=6.129,P=0.013,差异有统计学意义.获得HBsAg消失/血清学转换的患者中,HBeAg阴性患者平均治疗时间为(70.2±48.0)周,HBeAg阳性患者(81.3±39.4)周,差异无统计学意义(t=-0.522,P=0.602).结论 对聚乙二醇干扰素α-2a治疗HBV DNA和HBsAg应答良好的慢性乙型肝炎患者,延长疗程可提高HBsAg消失/血清学转换率,HBeAg阴性患者比HBeAg阳性患者更容易通过延长聚乙二醇干扰素α-2a治疗获得HBsAg的消失/血清学转换.
目的 探討延長聚乙二醇榦擾素α-2a療程對慢性乙型肝炎患者穫得HBsAg消失/血清學轉換的影響.方法將217例慢性乙型肝炎患者根據體質量分為＜60 kg和≥60 kg兩組,分彆皮下註射聚乙二醇榦擾素α-2a 135μg或180 μg,治療過程中根據患者外週血中性粒細胞數和血小闆數調整藥物劑量.每3箇月採用酶免疫化學髮光法定量檢測HBsAg/抗-HBs、HBeAg/抗-HBe,HBV DNA採用實時熒光定量聚閤酶鏈式反應檢測,將治療時間＞12週的患者納入統計分析,在治療過程中,對HBV DNA、HBsAg含量降低的患者,HBeAg含量下降的HBeAg暘性患者,治療48週後HBsAg含量＜200 IU/ml患者進行延長治療,經意嚮性分析治療患者HBsAg血清學轉換髮生率.採用x2檢驗進行統計學分析.結果 217例慢性乙型肝炎患者,治療時間為12.0～197.6週,平均(53.1±33.4)週,其中118例患者治療時間≥48週,89例治療時間＜48週.13.4%(29/217)的患者穫得HBsAg消失/HBsAg血清學轉換,其治療時間為17.6～197.6週,平均(75.4±42.8)週,其中治療時間＞48週24例(82.8%),小于48週5例(17.2%);HBV DNA平均轉陰時間為(20.8±8.9)週.148例HBeAg暘性患者中,9.5%(14/148)的患者穫得HBsAg消失/血清學轉換,在穫得HBsAg消失/血清學轉換的患者中,治療時間均＞48週(54～194週),平均(81.3±39.4)週.21.7%(15/69)的HBeAg陰性患者穫得HBsAg消失/血清學轉換,與HBeAg暘性患者的HBsAg消失/血清學轉換率(9.5%)比較,x2=6.129,P=0.013,差異有統計學意義.穫得HBsAg消失/血清學轉換的患者中,HBeAg陰性患者平均治療時間為(70.2±48.0)週,HBeAg暘性患者(81.3±39.4)週,差異無統計學意義(t=-0.522,P=0.602).結論 對聚乙二醇榦擾素α-2a治療HBV DNA和HBsAg應答良好的慢性乙型肝炎患者,延長療程可提高HBsAg消失/血清學轉換率,HBeAg陰性患者比HBeAg暘性患者更容易通過延長聚乙二醇榦擾素α-2a治療穫得HBsAg的消失/血清學轉換.
목적 탐토연장취을이순간우소α-2a료정대만성을형간염환자획득HBsAg소실/혈청학전환적영향.방법장217례만성을형간염환자근거체질량분위＜60 kg화≥60 kg량조,분별피하주사취을이순간우소α-2a 135μg혹180 μg,치료과정중근거환자외주혈중성립세포수화혈소판수조정약물제량.매3개월채용매면역화학발광법정량검측HBsAg/항-HBs、HBeAg/항-HBe,HBV DNA채용실시형광정량취합매련식반응검측,장치료시간＞12주적환자납입통계분석,재치료과정중,대HBV DNA、HBsAg함량강저적환자,HBeAg함량하강적HBeAg양성환자,치료48주후HBsAg함량＜200 IU/ml환자진행연장치료,경의향성분석치료환자HBsAg혈청학전환발생솔.채용x2검험진행통계학분석.결과 217례만성을형간염환자,치료시간위12.0～197.6주,평균(53.1±33.4)주,기중118례환자치료시간≥48주,89례치료시간＜48주.13.4%(29/217)적환자획득HBsAg소실/HBsAg혈청학전환,기치료시간위17.6～197.6주,평균(75.4±42.8)주,기중치료시간＞48주24례(82.8%),소우48주5례(17.2%);HBV DNA평균전음시간위(20.8±8.9)주.148례HBeAg양성환자중,9.5%(14/148)적환자획득HBsAg소실/혈청학전환,재획득HBsAg소실/혈청학전환적환자중,치료시간균＞48주(54～194주),평균(81.3±39.4)주.21.7%(15/69)적HBeAg음성환자획득HBsAg소실/혈청학전환,여HBeAg양성환자적HBsAg소실/혈청학전환솔(9.5%)비교,x2=6.129,P=0.013,차이유통계학의의.획득HBsAg소실/혈청학전환적환자중,HBeAg음성환자평균치료시간위(70.2±48.0)주,HBeAg양성환자(81.3±39.4)주,차이무통계학의의(t=-0.522,P=0.602).결론 대취을이순간우소α-2a치료HBV DNA화HBsAg응답량호적만성을형간염환자,연장료정가제고HBsAg소실/혈청학전환솔,HBeAg음성환자비HBeAg양성환자경용역통과연장취을이순간우소α-2a치료획득HBsAg적소실/혈청학전환.
Objective HBsAg loss and seroconversion in patients with chronic hepatitis B leads to long-lasting good clinical outcomes. The aim of this paper was to investigate to improve the rate of HBsAg loss and seroconversion in chronic hepatitis B patients by prolonged treatment of PEG-IFN α -2a. Methods 217 cases of HBeAg-positive or negative patients were collected from inpatient and outpatient in Beijing Ditan Hospital from May 2005 to October 2009 and subcutaeous injection of 135μg or 180μg PEGASYS were given once a week acording to body weights. The drug doses were adjusted acording to the neutrophilic granulocyte and platelet counts during treament course. Quantitative HBV DNA test was conducted using a commercially available real-time fluorescence quantitative PCR kit. The serum HBsAg/anti-HBs and HBeAg/anti-HBe were quantitatively detected by Abbott i 2000 chemiluminescent kit before and during treatment every three months. Patients with HBsAg steadily decreased and reached serum HBsAg level below 200 IU/ml after 48 weeks of treatment would receive prolonged treatment. Patients with more than 12 weeks of treatment entered into analysis. Main efficacy of prolonged treatment was evaluated by the incidences of HBsAg loss and seroconversion. Results The treatment courses of the 217 patients ranged from 12.0 to 197.6weeks with an average of 53.1±33.4 weeks, 118 cases took more than 48 weeks and another 89 cases less than 48 weeks. 13.4% (29/217) of patients achieved HBsAg loss or HBsAg seroconversion with treatment courses from 17.6 to 197.6 weeks (average 75.4±42.8 weeks). Among these 29 patients 24 (82.8%) received more than 48 weeks of treatment, but the treatment courses of HBV DNA reached undetectable level were 20.8±8.9 weeks. In this study, 9.5% (14/148) of HBeAg-positive patients acchieved HBsAg loss or seroconversion, all of them treated more than 48 weeks, from 48 to 194 weeks, average 81.32 ± 39.36 weeks.21.7% (15/69) of HBeAg-negative patients achieved HBsAg loss or seroconversion, significantly higher than that of HBeAg-positive patients (9.5%) (x2=6.129, P=0.013). The average treatment course for HBeAgnegative patients with HBsAg loss was 70.2±48.0 weeks, shorter than that of HBeAg-positive patients with HBsAg loss (81.3±39.4 weeks), but no significant difference (t=-0.522, P = 0.602) found between. Conclusion Higher rate of HBsAg loss and seroconversion could be obtained by individual extended treatment courses in patients with rapid HBV DNA and HBsAg response to PEG-IFN α -2a treatment and the HBeAgnegative patients could got higher rate of HBsAg loss than HBeAg-positive patients.
