CAJ | 학술논문

目的：观察聚乙二醇干扰素（PEG －IFN）α－2a 治疗 HBeAg 阴性慢性乙型肝炎（CHB）患者的疗效及其影响因素。方法收集2009年5月－2012年12月在南方医科大学南方医院感染内科就诊的 HBeAg 阴性的 CHB 患者103例，给予 PEG －IFNα－2a 135μg 治疗，平均疗程为13个月，治疗后随访48周，在治疗及随访期间每3个月检查肝功能、HBV DNA 定量。组间频数比较采用χ2检验，均数比较采用 t 检验，采用二分类多元 Logistic 回归法分析疗效的影响因素。结果103例患者治疗结束时，取得联合应答者84例，联合应答率为81．6％。随访过程中复发33例，复发率为39．3％，治疗后随访1年持续应答患者49例，持续应答率47．6％。经单因素和多因素分析，抗－HBe 阳性是唯一的与持续应答相关的独立影响因素（OR ＝3．69，P ＝0．013），HBV DNA 定量、HBV 基因型、前 C ／BCP 区变异、肝脏病理等其他治疗前基线特征与持续应答无相关性。结论PEG －IFNα－2a 治疗 HBeAg 阴性 CHB 能够取得较好的疗效，但复发率较高；抗－HBe 阳性患者的持续应答率较高。
목적：관찰취을이순간우소（PEG －IFN）α－2a 치료 HBeAg 음성만성을형간염（CHB）환자적료효급기영향인소。방법수집2009년5월－2012년12월재남방의과대학남방의원감염내과취진적 HBeAg 음성적 CHB 환자103례，급여 PEG －IFNα－2a 135μg 치료，평균료정위13개월，치료후수방48주，재치료급수방기간매3개월검사간공능、HBV DNA 정량。조간빈수비교채용χ2검험，균수비교채용 t 검험，채용이분류다원 Logistic 회귀법분석료효적영향인소。결과103례환자치료결속시，취득연합응답자84례，연합응답솔위81．6％。수방과정중복발33례，복발솔위39．3％，치료후수방1년지속응답환자49례，지속응답솔47．6％。경단인소화다인소분석，항－HBe 양성시유일적여지속응답상관적독립영향인소（OR ＝3．69，P ＝0．013），HBV DNA 정량、HBV 기인형、전 C ／BCP 구변이、간장병리등기타치료전기선특정여지속응답무상관성。결론PEG －IFNα－2a 치료 HBeAg 음성 CHB 능구취득교호적료효，단복발솔교고；항－HBe 양성환자적지속응답솔교고。
Objective To observe the efficacy of pegylated interferon α-2a (PEG -IFN α-2a)in HBeAg -negative chronic hepatitis B (CHB)patients and to analyze its influencing factors.Methods One hundred and three HBeAg -negative CHB patients,who visited De-partment of Infectious Diseases,Nanfang Hospital,Southern Medical University,from May 2009 to December 2012,were enrolled in this study.The patients were treated with 135 μg of PEG -IFN α-2a for a mean period of 13 months and then followed up for 48 weeks.During treatment and follow -up,alanine aminotransferase and hepatitis B virus (HBV)DNA levels were measured every three months for each pa-tient.The χ2 test or t test was used to compare the frequency or means between groups,and binary multivariate logistic regression analysis was performed to determine influencing factors.Results At the end of treatment,eighty -four (81.6%)of the 103 patients achieved a combined response.Among the patients who achieved a combined response,33 patients (39.3%)relapsed during follow -up and 49 pa-tients (47.6%)had a sustained response during follow -up within one year after treatment.Both univariate and multivariate statistical ana-lyses showed that only HBeAb positivity was an independent factor associated with sustained response(OR =3.69,P =0.013).Other base-line characteristics,including HBV DNA load,HBV genotype,preC /BCP mutation,and liver histopathology,are not associated with the sustained response.Conclusion PEG -IFN α-2a is an effective treatment for HBeAg -negative CHB,but the relapse rate is high.CHB patients with positive HBeAb have a higher rate of sustained response.