CAJ | 학술논문

目的：比较聚乙二醇干扰素α-2a 与替比夫定（LDT）治疗 HBeAg 阳性慢性乙型肝炎（CHB）的疗效。方法选取HBeAg 阳性慢性乙型肝炎患者71例，分为聚乙二醇干扰素α-2a 组33例和 LDT 组38例。比较2组治疗48周的疗效，并分析HBeAg 血清学转换的相关因素。结果治疗48周时，聚乙二醇干扰素α-2a 组和 LDT 组血清 HBV DNA 转阴率分别为54．5％和78．9％（P ＜0．05），ALT复常率分别为60．6％和81．5％（P ＜0．05），HBeAg血清转换率分别为36．4％和28．9％（P ＞0．05）。2组患者在治疗48周时 HBeAg 血清转换与基线ALT、HBV DNA 水平、HBeAg 水平无显著相关性（P ＞0．05）。多因素Logistic 回归分析显示，聚乙二醇干扰素α-2a 组治疗48周时 HBeAg 血清转换率与12、36、24周时 HBeAg 下降大于2log 相关；TLD 组治疗48周时 HBeAg 血清转换率与36、24、12周时 HBeAg 下降大于2log 相关。结论 TLD 组较聚乙二醇干扰素α-2a组有更高的 HBV DNA 转阴率及 ALT 复常率。36周 HBeAg 较基线下降大于2log 可作为2组患者治疗48周时 HBeAg 血清转换的最佳预测因素。12周时 HBeAg 较基线下降大于2log 作为聚乙二醇干扰素α-2a 组治疗48周时 HBeAg 血清转换最佳预测因素，36周 HBeAg 较基线下降大于2log 作为 TLD 组治疗48周时 HBeAg 血清转换最佳预测因素。
목적：비교취을이순간우소α-2a 여체비부정（LDT）치료 HBeAg 양성만성을형간염（CHB）적료효。방법선취HBeAg 양성만성을형간염환자71례，분위취을이순간우소α-2a 조33례화 LDT 조38례。비교2조치료48주적료효，병분석HBeAg 혈청학전환적상관인소。결과치료48주시，취을이순간우소α-2a 조화 LDT 조혈청 HBV DNA 전음솔분별위54．5％화78．9％（P ＜0．05），ALT복상솔분별위60．6％화81．5％（P ＜0．05），HBeAg혈청전환솔분별위36．4％화28．9％（P ＞0．05）。2조환자재치료48주시 HBeAg 혈청전환여기선ALT、HBV DNA 수평、HBeAg 수평무현저상관성（P ＞0．05）。다인소Logistic 회귀분석현시，취을이순간우소α-2a 조치료48주시 HBeAg 혈청전환솔여12、36、24주시 HBeAg 하강대우2log 상관；TLD 조치료48주시 HBeAg 혈청전환솔여36、24、12주시 HBeAg 하강대우2log 상관。결론 TLD 조교취을이순간우소α-2a조유경고적 HBV DNA 전음솔급 ALT 복상솔。36주 HBeAg 교기선하강대우2log 가작위2조환자치료48주시 HBeAg 혈청전환적최가예측인소。12주시 HBeAg 교기선하강대우2log 작위취을이순간우소α-2a 조치료48주시 HBeAg 혈청전환최가예측인소，36주 HBeAg 교기선하강대우2log 작위 TLD 조치료48주시 HBeAg 혈청전환최가예측인소。
Objective To compare the therapeutic effect between peginterferonα-2a and tel-bivudine (TLD)in treatment of patients with HBeAg positive chronic hepatitis B (CHB).Methods 71 patients with HBeAg positive CHB were divided into peginterferonα-2a group (n =33)and TLD group (n =38).Efficacy was compared and the HBeAg seroconversion factors were analyzed. Results 48 weeks after treatment,the negative conversion rates of serum HBV DNA in peginter-feronα-2a group and TLD group were 54.5% and 78.9% (P <0.05)respectively,the ALT nor-malization rates were 60.6% and 81.5% (P <0.05)respectively,the HBeAg seroconversion rates were 36.4% and 28.9% (P >0.05)respectively.There was no significant correlation between HBeAg seroconversion and ALT,HBV DNA HBeAg levels.The logistic regression analysis showed that the HBeAg seroconversion ratio in the peginterferonα-2a group at the 48th week was closely re-lated to 3 factors:the HBeAg decreased more than 2log at the 12th,24th and 36th week.The HBeAg seroconversion ratio in theTLDgroup at the4 8 thweekwas closely associatedwith 3 factors :the HBeAg decreased more than 2 log at the 3 6 th ,2 4 th and 1 2 th week .Conclusion The negative conversion rate of HBV DNA and ALT normalization rate in patients with HBeAg posi-tive CHB after 48 weeks therapy in TLD group are higher than those in peginterferonα-2a group. The HBeAg decreased more than 2log from the baseline to the 36th week can be used as the best predictor for the HBeAg seroconversion rate after the 48th week therapy in both groups.The HBeAg decreased more than 2log from the baseline to the 12th week can be used as the best pre-dictor for the HBeAg seroconversion rate after the 48th week therapy in the peginterferonα-2a group,and the HBeAg decreased more than 2log from the baseline to the 36th week can be used as the best predictor for the HBeAg seroconversion rate after the 48th week therapy in the TLD group.