【摘要】 目的比较聚乙二醇干扰素α-2a与替比夫定(LDT)治疗HBeAg阳性慢性乙型肝炎(CHB)的疗效。方法选取HBeAg阳性慢性乙型肝炎患者71例,分为聚乙二醇干扰素α-2a组33例和LDT组38例。比较2组治疗48周的疗效,并分析HBeAg血清学转换的相关因素。结果治疗48周时,聚乙二醇干扰素α-2a组和LDT组血清HBV DNA转阴率分别为54.5%和78.9%(P<0.05),ALT复常率分别为60.6%和81.5%(P<0.05),HBeAg血清转换率分别为36.4%和28.9%(P>0.05)。2组患者在治疗48周时HBeAg血清转换与基线ALT、HBV DNA水平、HBeAg水平无显著相关性(P>0.05)。多因素Logistic回归分析显示,聚乙二醇干扰素α-2a组治疗48周时HBeAg血清转换率与12、36、24周时HBeAg下降大于2log相关;TLD组治疗48周时HBeAg血清转换率与36、24、12周时HBeAg下降大于2log相关。结论 TLD组较聚乙二醇干扰素α-2a组有更高的HBV DNA转阴率及ALT复常率。36周HBeAg较基线下降大于2log可作为2组患者治疗48周时HBeAg血清转换的最佳预测因素。12周时HBeAg较基线下降大于2log作为聚乙二醇干扰素α-2a组治疗48周时HBeAg血清转换最佳预测因素,36周HBeAg较基线下降大于2log作为TLD组治疗48周时HBeAg血清转换最佳预测因素。更多还原

【Abstract】 Objective To compare the therapeutic effect between peginterferon α-2a and telbivudine( TLD) in treatment of patients with HBeAg positive chronic hepatitis B( CHB). Methods71 patients with HBeAg positive CHB were divided into peginterferon α-2a group( n = 33) and TLD group( n = 38). Efficacy was compared and the HBeAg seroconversion factors were analyzed. Results48 weeks after treatment,the negative conversion rates of serum HBV DNA in peginterferon α-2a group and TLD group were 54. 5% and 78. 9%( P < 0. 05) respectively,the ALT normalization rates were 60. 6% and 81. 5%( P < 0. 05) respectively,the HBeAg seroconversion rates were 36. 4%and 28. 9%( P > 0. 05) respectively. There was no significant correlation between HBeAg seroconversion and ALT,HBV DNA HBeAg levels. The logistic regression analysis showed that the HBeAg seroconversion ratio in the peginterferon α-2a group at the 48th week was closely related to3 factors: the HBeAg decreased more than 2log at the 12th, 24th and 36th week. The HBeAg seroconversion ratio in the TLD group at the 4 8 th week was closely associated with 3 factors :the HBeAg decreased more than 2 log at the 3 6 th,2 4 th and 1 2 th week. Conclusion The negative conversion rate of HBV DNA and ALT normalization rate in patients with HBeAg positive CHB after 48 weeks therapy in TLD group are higher than those in peginterferon α-2 a group. The HBeAg decreased more than 2 log from the baseline to the 36 th week can be used as the best predictor for the HBeAg seroconversion rate after the 48 th week therapy in both groups. The HBeAg decreased more than 2 log from the baseline to the 12 th week can be used as the best predictor for the HBeAg seroconversion rate after the 48 th week therapy in the peginterferon α-2 a group,and the HBeAg decreased more than 2 log from the baseline to the36 th week can be used as the best predictor for the HBeAg seroconversion rate after the 48 th week therapy in the TLD group.更多还原