CAJ | 학술논문

目的：探讨血清乙肝表面抗原（HBsAg）定量检测在预测干扰素治疗HBeAg 阳性慢性乙型肝炎远期疗效中的价值。方法：对75例HBeAg 阳性慢性乙型肝炎患者采用聚乙二醇干扰素α－2a，180μg，皮下注射，每周1次，连续48周后停用，完成治疗后随访24周；治疗及随访期间定期检测血清HBsAg 及HBV DNA水平变化。结果：治疗结束后随访24周，根据血清HBV DNA 变化情况将患者分为病毒学持续应答组、无应答组及复发组。在治疗第12、24及48周，持续应答组与复发组相比，血清HBV DNA 水平差异无显著性，且均明显低于无应答组；而在治疗第12、24及48周，持续应答组血清HBsAg 定量检测水平明显低于复发组，复发组与无应答组差异无显著性。在治疗第12周，血清HBsAg 水平下降幅度≥1 log10 IU／mL 对预测持续病毒学应答的敏感性、特异性、阳性预测值及阴性预测值分别为86％、94％、95％及94％；通过受试者工作特征曲线评估治疗第12周血清HBsAg 水平下降幅度≥1 log10 IU／mL 对预测患者病毒学持续应答的价值，得出的曲线下面积为0．952。结论：血清HBV DNA 水平的变化不能有效预测治疗结束后患者能否达到持续病毒学应答，但血清HBsAg 定量检测可作为预测干扰素治疗HBeAg 阳性慢性乙型病毒性肝炎患者疗效的理想指标。
목적：탐토혈청을간표면항원（HBsAg）정량검측재예측간우소치료HBeAg 양성만성을형간염원기료효중적개치。방법：대75례HBeAg 양성만성을형간염환자채용취을이순간우소α－2a，180μg，피하주사，매주1차，련속48주후정용，완성치료후수방24주；치료급수방기간정기검측혈청HBsAg 급HBV DNA수평변화。결과：치료결속후수방24주，근거혈청HBV DNA 변화정황장환자분위병독학지속응답조、무응답조급복발조。재치료제12、24급48주，지속응답조여복발조상비，혈청HBV DNA 수평차이무현저성，차균명현저우무응답조；이재치료제12、24급48주，지속응답조혈청HBsAg 정량검측수평명현저우복발조，복발조여무응답조차이무현저성。재치료제12주，혈청HBsAg 수평하강폭도≥1 log10 IU／mL 대예측지속병독학응답적민감성、특이성、양성예측치급음성예측치분별위86％、94％、95％급94％；통과수시자공작특정곡선평고치료제12주혈청HBsAg 수평하강폭도≥1 log10 IU／mL 대예측환자병독학지속응답적개치，득출적곡선하면적위0．952。결론：혈청HBV DNA 수평적변화불능유효예측치료결속후환자능부체도지속병독학응답，단혈청HBsAg 정량검측가작위예측간우소치료HBeAg 양성만성을형병독성간염환자료효적이상지표。
Objective To explore the value of serum HBsAg quantification in prediction of interferon treatment of HBeAg-positive chronic hepatitis B (CHB). Methods 75 patients with HBeAg-positive CHB received peginterferon alfa-2a (PegIFNα-2a) at a dose of 180 μg weekly for 48 weeks with 24 weeks of a pose-treatment follow-up. Serum HBsAg quantification and level of HBV DNA were measured during the treatment and the pose-treatment follow-up. Results In the post-treatment follow-up , the patients were divided into sustained response (SR) group, relapse group, and non-response group. Serum level of HBV DNA did not differ significantly between SR group and relapse group , but was lower than that in non-response group. However , there was no significant difference in HBsAg quantification between relapse group and non-response group , but the level of quantification was higher in both group than in SR group. Serum HBsAg declined more than 1 log10 IU/mL at week 12 , with sensitivity , specificity , and positive and negative predictive value of 86%, 94%, 95%and 94%. The accuracy of the cut-off with a 1 log10 IU/mL decrease in HBsAg level at week 12 of PegIFNα-2a therapy to predict SVR was assessed using receiver operating characteristic curve , and the area under the curve was 0.952. Conclusion The change in serum HBV DNA level could not predict SR effectively, but serum HBsAg quantification is an ideal parameter for predicting the efficacy of interferon therapy.