实用肝脏病杂志
實用肝髒病雜誌
실용간장병잡지
JOURNAL OF CLINICAL HEPATOLOGY
2015年
5期
476-481
,共6页
慢性乙型肝炎%阿德福韦酯%聚乙二醇干扰素α-2a%疗效预测
慢性乙型肝炎%阿德福韋酯%聚乙二醇榦擾素α-2a%療效預測
만성을형간염%아덕복위지%취을이순간우소α-2a%료효예측
Chronic hepatitis B%Adefovir dipivoxil%Peginterferonα-2a%Efficacy%Prediction
目的：分析聚乙二醇干扰素（PEG-IFNα-2a）联合阿德福韦酯（ADV）治疗HBeAg阳性慢性乙型肝炎（CHB）患者48 w时的疗效及其预测因素。方法将196例HBeAg阳性CHB患者分为PEG-IFNα-2a治疗64例， ADV治疗66例和PEG-IFNα-2a联合ADV治疗66例，疗程均为48 w。采用ELISA法检测INF-γ和IL-10；采用Achitect（Abbott）微粒子化学发光免疫分析法检测HBeAg定量。结果在治疗48 w时，联合组HBV DNA阴转率、HBeAg阴转率、HBeAg转换率和ALT复常率分别为74.2%、24.2%、48.5%和80.3%，显著高于干扰素组（53.1%、10.9%、29.7%和54.7%，P<0.05）和阿德福韦组（62.1%、13.6%、9.1%和65.2%，P<0.05）；联合组INF-γ水平为（45.3±11.3） pg/ml，显著高于干扰素组[（37.1±10.3） pg/ml，P<0.05]和阿德福韦组[（36.3±11.5） pg/ml，P<0.05]；联合组IL-10水平为（10.3±14.6） pg/ml，显著低于干扰素组[（17.1±11.3） pg/ml，P<0.05]和阿德福韦组[（18.3±10.5） pg/ml，P<0.05]；联合组治疗48 w时HBeAg血清学转换与治疗24 w时HBeAg水平下降的百分比有关，即治疗24 w时HBeAg水平较基线下降大于89.1%的阳性预测值为88.7%，阴性预测值（NPV）为81.9%，灵敏度为83.1%，特异度为87.9%。结论 PEG-IFNα-2a联合ADV治疗HBeAg阳性慢性乙型肝炎能增强机体细胞免疫应答，疗效优于单药治疗，其中治疗24 w时HBeAg下降的百分比可预测48 w时的疗效。
目的：分析聚乙二醇榦擾素（PEG-IFNα-2a）聯閤阿德福韋酯（ADV）治療HBeAg暘性慢性乙型肝炎（CHB）患者48 w時的療效及其預測因素。方法將196例HBeAg暘性CHB患者分為PEG-IFNα-2a治療64例， ADV治療66例和PEG-IFNα-2a聯閤ADV治療66例，療程均為48 w。採用ELISA法檢測INF-γ和IL-10；採用Achitect（Abbott）微粒子化學髮光免疫分析法檢測HBeAg定量。結果在治療48 w時，聯閤組HBV DNA陰轉率、HBeAg陰轉率、HBeAg轉換率和ALT複常率分彆為74.2%、24.2%、48.5%和80.3%，顯著高于榦擾素組（53.1%、10.9%、29.7%和54.7%，P<0.05）和阿德福韋組（62.1%、13.6%、9.1%和65.2%，P<0.05）；聯閤組INF-γ水平為（45.3±11.3） pg/ml，顯著高于榦擾素組[（37.1±10.3） pg/ml，P<0.05]和阿德福韋組[（36.3±11.5） pg/ml，P<0.05]；聯閤組IL-10水平為（10.3±14.6） pg/ml，顯著低于榦擾素組[（17.1±11.3） pg/ml，P<0.05]和阿德福韋組[（18.3±10.5） pg/ml，P<0.05]；聯閤組治療48 w時HBeAg血清學轉換與治療24 w時HBeAg水平下降的百分比有關，即治療24 w時HBeAg水平較基線下降大于89.1%的暘性預測值為88.7%，陰性預測值（NPV）為81.9%，靈敏度為83.1%，特異度為87.9%。結論 PEG-IFNα-2a聯閤ADV治療HBeAg暘性慢性乙型肝炎能增彊機體細胞免疫應答，療效優于單藥治療，其中治療24 w時HBeAg下降的百分比可預測48 w時的療效。
목적：분석취을이순간우소（PEG-IFNα-2a）연합아덕복위지（ADV）치료HBeAg양성만성을형간염（CHB）환자48 w시적료효급기예측인소。방법장196례HBeAg양성CHB환자분위PEG-IFNα-2a치료64례， ADV치료66례화PEG-IFNα-2a연합ADV치료66례，료정균위48 w。채용ELISA법검측INF-γ화IL-10；채용Achitect（Abbott）미입자화학발광면역분석법검측HBeAg정량。결과재치료48 w시，연합조HBV DNA음전솔、HBeAg음전솔、HBeAg전환솔화ALT복상솔분별위74.2%、24.2%、48.5%화80.3%，현저고우간우소조（53.1%、10.9%、29.7%화54.7%，P<0.05）화아덕복위조（62.1%、13.6%、9.1%화65.2%，P<0.05）；연합조INF-γ수평위（45.3±11.3） pg/ml，현저고우간우소조[（37.1±10.3） pg/ml，P<0.05]화아덕복위조[（36.3±11.5） pg/ml，P<0.05]；연합조IL-10수평위（10.3±14.6） pg/ml，현저저우간우소조[（17.1±11.3） pg/ml，P<0.05]화아덕복위조[（18.3±10.5） pg/ml，P<0.05]；연합조치료48 w시HBeAg혈청학전환여치료24 w시HBeAg수평하강적백분비유관，즉치료24 w시HBeAg수평교기선하강대우89.1%적양성예측치위88.7%，음성예측치（NPV）위81.9%，령민도위83.1%，특이도위87.9%。결론 PEG-IFNα-2a연합ADV치료HBeAg양성만성을형간염능증강궤체세포면역응답，료효우우단약치료，기중치료24 w시HBeAg하강적백분비가예측48 w시적료효。
Obiective To analyze the efficacy and the predictive factors of peginterferon α-2a (PEG-IFNα-2a) and adefovir dipivoxil (ADV) combination therapy in patients with HBeAg-positive chronic hepatitis B (CHB). Methods 196 CHB patients positive for HBeAg were divided into PEG-IFNα-2a monotherapy group (n=64),ADV monotherapy group (n=66),and PEG-IFNα-2a plus ADV combination therapy group (n=66). All patients were treated for 48 weeks. Serum INF-γ and IL-10 levels were detected by ELISA. Results At the end of 48 weeks,the serum HBV DNA loss,HBeAg negative,HBeAg seroconversion and ALT normalization rates in PEG-IFNα-2a plus ADV group (74.2%,24.2%,48.5% and 80.3%) were significantly higher than in ADV group (62.1%,13.6%,9.1% and 65.2%,P<0.05) and in PEG-IFNα-2a group (53.1%,10.9%,29.7% and 54.7%,P<0.05);Serum INF-γ levels in combined treatment group [(45.3 ±11.3) pg/ml] were significantly higher than in ADV group [(36.3±11.5) pg/ml,P<0.05] and in PEG-IFNα-2a group [(37.1±10.3) pg/ml,P<0.05];Serum IL-10 levels in combined treatment group [(10.3±14.6) pg/ml] were significantly lower than in ADV group [(18.3±10.5) pg/ml,P<0.05] and in PEG-IFNα-2a group [(17.1±11.3) pg/ml,P<0.05];Serum HBeAg seroconversion rate in com-bined treatment group at the end of 48 weeks was associated with the negative rate of HBeAg at 24 weeks ,e.g. greater than 89.1% reduction of serum HBeAg levels at 24 weeks than baseline had a positive predictive value of 88.7%,negative predictive value of 81.9%,sensitivity of 83.1% and specificity of 87.9%. Conclusion The effica-cy of pegylated interferon α-2a combination with adefovir dipivoxil therapy is superior to monotherapy of either of them in HBeAg-positive chronic hepatitis B patients and the reduction of HBeAg levels at 24 weeks could predict the efficacy of 48 weeks.
