CAJ | 학술논문

目的：探讨经恩替卡韦（ETV）长期治疗后，未达到停药标准的 HBeAg 阳性慢性乙型肝炎患者序贯联合聚乙二醇干扰素的疗效以及 HBeAg／HBsAg 消失和血清学转换的预测因素。方法回顾性分析58例 HBeAg 阳性 CHB 患者接受 ETV 治疗后，实现病毒学阴转（HBV DNA＜500拷贝／mL），但 HBeAg 仍为阳性的患者，A 组5 S／CO＜HBeAg≤50 S／CO 28例，B 组50 S／CO＜HBeAg≤100 S／CO 30例。加用聚乙二醇干扰素α-2a（Peg-IFNα-2a）联合治疗48周，比较序贯联合时基线 HBeAg 水平与治疗48周后 HBeAg 消失或转换的相关性，并对疗效作出评估。结果序贯联合治疗后 A组 HBeAg 消失16例，占57．1％；B 组 HBeAg 消失9例，占30％，两组比较差异有统计学意义（χ2＝4．351，P ＜0．05）。HBeAg 血清转换 A 组13例，占46．4％；B 组5 例，占16．7％，两组比较差异有统计学意义（χ2＝5．994，P ＜0．05）。8例序贯治疗后出现 HBsAg 消失的患者均来自于 A 组，又按基线 HBsAg≤1000 IU／mL 的患者与基线 HBsAg＞1000 IU／mL的患者进行比较，差异无统计学意义（31．3％ vs．25％，χ2＝0．131，P ＞0．05）。结论ETV 长期治疗未出现 HBeAg 血清学转换的患者，加用 Peg-IFNα-2a 时基线血清 HBeAg 水平，对治疗后 HBeAg 消失具有预测价值；基线 HBeAg≤50 S／CO的患者，序贯联合治疗后可获得更多的 HBeAg 及 HBsAg 阴转趋势，是核苷（酸）类似物经治序贯联合聚乙二醇干扰素的优选人群。
목적：탐토경은체잡위（ETV）장기치료후，미체도정약표준적 HBeAg 양성만성을형간염환자서관연합취을이순간우소적료효이급 HBeAg／HBsAg 소실화혈청학전환적예측인소。방법회고성분석58례 HBeAg 양성 CHB 환자접수 ETV 치료후，실현병독학음전（HBV DNA＜500고패／mL），단 HBeAg 잉위양성적환자，A 조5 S／CO＜HBeAg≤50 S／CO 28례，B 조50 S／CO＜HBeAg≤100 S／CO 30례。가용취을이순간우소α-2a（Peg-IFNα-2a）연합치료48주，비교서관연합시기선 HBeAg 수평여치료48주후 HBeAg 소실혹전환적상관성，병대료효작출평고。결과서관연합치료후 A조 HBeAg 소실16례，점57．1％；B 조 HBeAg 소실9례，점30％，량조비교차이유통계학의의（χ2＝4．351，P ＜0．05）。HBeAg 혈청전환 A 조13례，점46．4％；B 조5 례，점16．7％，량조비교차이유통계학의의（χ2＝5．994，P ＜0．05）。8례서관치료후출현 HBsAg 소실적환자균래자우 A 조，우안기선 HBsAg≤1000 IU／mL 적환자여기선 HBsAg＞1000 IU／mL적환자진행비교，차이무통계학의의（31．3％ vs．25％，χ2＝0．131，P ＞0．05）。결론ETV 장기치료미출현 HBeAg 혈청학전환적환자，가용 Peg-IFNα-2a 시기선혈청 HBeAg 수평，대치료후 HBeAg 소실구유예측개치；기선 HBeAg≤50 S／CO적환자，서관연합치료후가획득경다적 HBeAg 급 HBsAg 음전추세，시핵감（산）유사물경치서관연합취을이순간우소적우선인군。
Objective To observe the curative effects of sequential therapy with peginterferon alfa-2a (Peg-IFNα-2a) on HBeAg-positive chronic hepatitis B (CHB)patients who had received long-term antiviral treatment with entecavir (ETV) without a satisfactory end point,and investigate the predictors of HBeAg/HBsAg loss.Methods Fifty-eight cases of HBeAg positive CHB patients with a standard ETV monotherapy course (from 120 weeks to 244 weeks),who had achieved a virological response (defined as HBV DNA <500 copies/ml)but without HBeAg seroconversion,were retrospectively analyzed.These patients were divided into two groups based on serum HBeAg levels (group A:n=28,5 S/CO<HBeAg level≤50 S/CO;group B:n=30,50 S/CO< HBeAg level≤ 100 S/CO),then they were sequentially treated with Peg-IFNα-2a for 48 weeks.Inter-group differences were statistically evaluated by Chi-squared test.Results After the sequential treatment,group A showed significantly higher rates of HBeAg loss (57.14% vs.30%,χ2 = 4.351 ,P < 0.05 )and seroconversion (46.43% vs.16.7%,x?=5.994,P<0.05)than group B.Eight cases of HBsAg loss among the 58 cases were from group A.According to the baseline level of HBsAg before peginterferon treatment,patients with low level of HBsAg (HBsAg≤1000 IU/ml )didn't achieve a statically higher rate of HBsAg loss than those with high level of HBsAg at the end of peginterferon therapy (31 .3% vs.25%,χ2 =0.131 ,P >0.05).Conclusion Baseline level of HBeAg could be a curative effect predictor of peg-IFNα-2a sequential therapy for CHB patients who have received unsatisfactory entecavir treatment.Patients with low baseline levels of HBeAg based on NUC treatment tend to achieve more HBeAg/HBsAg loss and should be suggested to receive sequential therapy with peg-IFNα-2a.