南方医科大学学报

南方医科大学学报 ›› 2015, Vol. 35 ›› Issue (06): 807-.

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HBeAg阳性慢性乙型肝炎患者干扰素治疗24周应答不佳时的治疗方案

王欣欣，袁国盛，赖静兰，杨年欢，张 浩，王俊洁，周元平   

  • 出版日期:2015-06-20 发布日期:2015-06-20

Treatment options in HBeAg-positive chronic hepatitis B patients with a poor response to 24-week interferon monotherapy

  • Online:2015-06-20 Published:2015-06-20

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摘要： 目的对干扰素单药治疗24周应答不佳的HBeAg阳性慢性乙型肝炎（CHB）患者采用不同的治疗方案进行后续治疗，分析
比较其疗效和安全性。方法回顾性分析2010年9月~2013年1月南方医科大学南方医院193例干扰素治疗24周时应答不佳的
HBeAg阳性的CHB患者，根据不同后续治疗方案分成：联用恩替卡韦（ETV）或阿德福韦（ADV）治疗（A组），继续干扰素单药治
疗（B组），换为NAs治疗（C组），直接停止治疗（D组）。观察比较第24、48、72周时各组患者的临床疗效与安全性。结果继续治
疗至疗程48 周时，A组和C组HBV DNA转阴率、ALT 复常率均高于B组（A组：χ2=26.808，P<0.001 和χ2=5.485，P=0.017；C
组：χ2=21.257，P<0.001 和χ2=5.369，P=0.018）；同时发现，加ETV组HBV DNA转阴率高于加ADV组（χ2=8.255，P=0.004）。疗
程72周时，A组患者有27例（39.7%）发生HBeAg血清学转换，明显高于B、C两组（χ2=4.238，P=0.04 和χ2=7.681，P=0.006）；58例
（85.3%）获得HBV DNA转阴，59例（86.8%）ALT恢复正常，均高于B组（χ2=23.018，P<0.001和χ2=5.987，P=0.014），但与C组比
较差异无统计学意义（P>0.05）；同时发现，联合ETV组HBV DNA转阴率和HBeAg血清学转换率均高于加ADV组（χ2=9.823，
P=0.002 和χ2=5.450，P=0.020）。D组，28例患者的HBV DNA均持续较高水平复制，HBeAg水平升高，ALT反复波动。结论对
于干扰素单药治疗24周时应答不佳的CHB患者，联用NAs并延长疗程可明显提高HBeAg血清学转换率、HBV DNA转阴率及
ALT复常率，特别是联用ETV并延长疗程时。

Abstract: Objective To evaluate the efficacy and safety of 4 treatment options for HBeAg-positive chronic hepatitis B (CHB)
patients following a suboptimal response to 24-week interferon monotherapy. Methods The data of 193 HBeAg-positive CHB
patients with suboptimal response to 24-week interferon monotherapy were collected from Nanfang Hospital between
September, 2010 and January, 2013. According to the subsequent treatments, the patients were divided into group A with
additional entecavir or adefovir, group B with further interferon monotherapy, group C with conversion to NAs therapy, and
group D with direct therapy withdrawal, and the biochemical and virological results at weeks 24, 48 and 72 were analyzed in
the 4 groups. Results At week 48, the HBV DNA negative rates and serum alanine aminotransferase (ALT) normalization rates
were both significantly higher in group A and C than in group B (P<0.05); in group A, ETV therapy subgroup had a
significantly higher HBV DNA negative rate than ADV therapy subgroup at week 48 (90.3% vs 59.5%, χ2=8.255, P=0.004). At
week 72, 39.7%(27/68) of the patients in group A achieved HBeAg seroconversion, a rate significantly higher than those in
groups B (χ2=4.238, P=0.040) and C (χ2=7.681, P=0.006); the HBV DNA negative rate and ALT normalization rate in group A
were 85.3%(58/68) and 86.8%(59/68), respectively, both significantly higher than those in group B (χ2=23.018, P<0.001; χ2=5.987,
P=0.014) but comparable to those in group C (P>0.05). In the two subgroups in group A, the HBV DNA negative rate and
HBeAg seroconversion rate were both significantly higher in ETV subgroup (χ2=9.823, P=0.002; χ2=5.450, P=0.020). In group D,
all the patients remained HBeAg-positive with abnormal ALT levels and high level of HBV DNA. Conclusion For HBeAg-positive CHB patients with
suboptimal response to 24-week interferon monotherapy, combined treatment with NAs (especially ETV) and extension of the treatment
course can significantly improve the HBeAg seroconversion rates, HBV DNA negative rates, and ALT normalization rates.