中华肝脏病杂志
中華肝髒病雜誌
중화간장병잡지
CHINESE JOURNAL OF HEPATOLOGY
2008年
4期
279-282
,共4页
钟锐兴%赖春颜%梁东%龙辉
鐘銳興%賴春顏%樑東%龍輝
종예흥%뢰춘안%량동%룡휘
肝炎,乙型,慢性%扰素α-2a%治疗
肝炎,乙型,慢性%擾素α-2a%治療
간염,을형,만성%우소α-2a%치료
Hepatitis B,chronic%Interferon alpha-2a%Therapy
目的 观察聚乙二醇化干扰素(PEG-IFN)α-2a治疗慢性乙型肝炎患者抗病毒的疗效及影响抗病毒疗效的因素. 方法 将102例ALT＞2×正常值上限(ULN)的慢性乙型肝炎患者分成HBeAg阳性和HBeAg阴性两组,用PEG-IFN α-2a 180μg皮下注射,每周1次治疗,患者基本疗程12个月,6个月无治疗应答者停药.观察治疗结束时及治疗结束后6、12、18、24、30个月应答情况.观察ALT水平,HBV DNA载量及肝组织炎症和纤维化程度对治疗应答的影响.结果 (1)HBeAg阳性组患者治疗结束时的完全应答率及停药后6、12、18、24、30个月的完全应答率与HBeAg阴性组患者相似,差异均无统计学意义.(2)HBeAg阳性组患者治疗前ALT＞3×ULN者治疗结束时的完全应答率为78.8%,2×ULN＜ALT≤3 ×ULN患者完全应答率为52.2%,差异有统计学意义(x 2=4.40,P＜0.05),而HBeAg阴性组患者,差异无统计学意义.(3)治疗前HBV DNA载量水平(低、中、高3个组),HBeAg阳性和HBeAg阴性组患者治疗结束时的完全应答率,差异均无统计学意义.(4)HBeAg阳性组患者治疗前肝组织炎症G3、G4组完全应答率为85.7%,G1、G2组患者完全应答率为55.9%,差异有统计学意义(x2=4.19,P＜0.05),而HBeAg阴性组患者分别为81.8%和79.2%,差异无统计学意义.HBeAg阳性和HBeAg阴性组患者肝纤维化程度S1、S2组与S3、S4组的治疗完全应答率比较,差异均无统计学意义. 结论 PEG-IFN α-2a对HBeAg阳性和HBeAg阴性的慢性乙型肝炎患者均有较好的治疗应答.对肝组织炎症活动度高(G3、G4)和血清ALT高水平(＞3×ULN)的患者,PEG-IFNα-2a治疗的疗效好.
目的 觀察聚乙二醇化榦擾素(PEG-IFN)α-2a治療慢性乙型肝炎患者抗病毒的療效及影響抗病毒療效的因素. 方法 將102例ALT＞2×正常值上限(ULN)的慢性乙型肝炎患者分成HBeAg暘性和HBeAg陰性兩組,用PEG-IFN α-2a 180μg皮下註射,每週1次治療,患者基本療程12箇月,6箇月無治療應答者停藥.觀察治療結束時及治療結束後6、12、18、24、30箇月應答情況.觀察ALT水平,HBV DNA載量及肝組織炎癥和纖維化程度對治療應答的影響.結果 (1)HBeAg暘性組患者治療結束時的完全應答率及停藥後6、12、18、24、30箇月的完全應答率與HBeAg陰性組患者相似,差異均無統計學意義.(2)HBeAg暘性組患者治療前ALT＞3×ULN者治療結束時的完全應答率為78.8%,2×ULN＜ALT≤3 ×ULN患者完全應答率為52.2%,差異有統計學意義(x 2=4.40,P＜0.05),而HBeAg陰性組患者,差異無統計學意義.(3)治療前HBV DNA載量水平(低、中、高3箇組),HBeAg暘性和HBeAg陰性組患者治療結束時的完全應答率,差異均無統計學意義.(4)HBeAg暘性組患者治療前肝組織炎癥G3、G4組完全應答率為85.7%,G1、G2組患者完全應答率為55.9%,差異有統計學意義(x2=4.19,P＜0.05),而HBeAg陰性組患者分彆為81.8%和79.2%,差異無統計學意義.HBeAg暘性和HBeAg陰性組患者肝纖維化程度S1、S2組與S3、S4組的治療完全應答率比較,差異均無統計學意義. 結論 PEG-IFN α-2a對HBeAg暘性和HBeAg陰性的慢性乙型肝炎患者均有較好的治療應答.對肝組織炎癥活動度高(G3、G4)和血清ALT高水平(＞3×ULN)的患者,PEG-IFNα-2a治療的療效好.
목적 관찰취을이순화간우소(PEG-IFN)α-2a치료만성을형간염환자항병독적료효급영향항병독료효적인소. 방법 장102례ALT＞2×정상치상한(ULN)적만성을형간염환자분성HBeAg양성화HBeAg음성량조,용PEG-IFN α-2a 180μg피하주사,매주1차치료,환자기본료정12개월,6개월무치료응답자정약.관찰치료결속시급치료결속후6、12、18、24、30개월응답정황.관찰ALT수평,HBV DNA재량급간조직염증화섬유화정도대치료응답적영향.결과 (1)HBeAg양성조환자치료결속시적완전응답솔급정약후6、12、18、24、30개월적완전응답솔여HBeAg음성조환자상사,차이균무통계학의의.(2)HBeAg양성조환자치료전ALT＞3×ULN자치료결속시적완전응답솔위78.8%,2×ULN＜ALT≤3 ×ULN환자완전응답솔위52.2%,차이유통계학의의(x 2=4.40,P＜0.05),이HBeAg음성조환자,차이무통계학의의.(3)치료전HBV DNA재량수평(저、중、고3개조),HBeAg양성화HBeAg음성조환자치료결속시적완전응답솔,차이균무통계학의의.(4)HBeAg양성조환자치료전간조직염증G3、G4조완전응답솔위85.7%,G1、G2조환자완전응답솔위55.9%,차이유통계학의의(x2=4.19,P＜0.05),이HBeAg음성조환자분별위81.8%화79.2%,차이무통계학의의.HBeAg양성화HBeAg음성조환자간섬유화정도S1、S2조여S3、S4조적치료완전응답솔비교,차이균무통계학의의. 결론 PEG-IFN α-2a대HBeAg양성화HBeAg음성적만성을형간염환자균유교호적치료응답.대간조직염증활동도고(G3、G4)화혈청ALT고수평(＞3×ULN)적환자,PEG-IFNα-2a치료적료효호.
Objective To study the responses of peginterferon-alpha 2a antiviral therapy in chronic hepatitis B(CHB)patients.Methods One hundred two CHB patients with their serum ALT values higher than 2×the upper limit of the normal(ULN)were divided into a HBeAg-positive and a HBeAg-negative group.All patients were treated with peginterferon-alpha 2a by subcutaneous injection(180 microgram once weekly).After treatment for 6 months,patients without a defined therapeutic response were dropped from the treatment group;the others completed a 12 month therapy.The sustained response and the antiviral effect of the treatment were assessed at the end of the therapy.To investigate the possible impact factors of the response to pegintefferon-alpha 2a,we studied the therapeutic response of patients with different serum ALT levels, inflammation grades of liver histology,stages of fibrosis,and HBV viral load levels.Results(1)There was no statistical difference of the rates of response at the end of treatment and 6,12,18,24 and 30 months after the cessation of therapy between the HBeAg-positive and the HBeAg-negative groups.(2)In the HBeAgpositive group.the rates of response of patients with serum ALT values＞3×ULN were significantly higher than those with serumALT values≤3×ULN(x2=4.40,P＜0.05).However,no statistical difference of serum ALT levels was found in the HBeAg-negative group.(3)In both HBeAg-positive and HBeAg-negative groups,no difference was revealed in the rates of response among patients with different levels of HBV viral loads.(4)In the HBeAg-positive group,patients with more severe liver inflammation histologically(G3 and G4) had significantly higher response rates than those with milder inflammation(G1 and G2)(X2=4.19,P＜0.05),but no similar statistical differences were found in the HBe Ag-negative group.Moreover. there was no difference in the rates of response among patients in different stages of liver fibrosis in both HBe Ag positive and HBeAg-negative groups.Conclusions Similar rates of response and sustained virological response to the peginterferon-alpha 2a treatment can be achieved in both HBeAg-positive and HBeAg-nega-tive patients.Hepatic fibrosis is not a predictor of poor therapeutic response.For HBeAg-positive patients,more severe liver inflammation identified with liver biopsies(G3 or G4)and high serum ALT values(＞3×ULN)Can be considered as predictors of a good therapeutic response.
