【摘要】 目的对长期口服恩替卡韦治疗的慢性乙型肝炎(CHB)患者换用干扰素治疗,为临床上针对长期口服核苷(酸)类似物的CHB患者提供一种可行的安全停药方案。方法长期口服恩替卡韦治疗的CHB患者120例,接受恩替卡韦治疗时间为7~11(8.4±2.6)年。60例观察组患者采取口服恩替卡韦与注射重组人干扰素α2b联合治疗12 w,然后单独应用干扰素α2b至48 w,而60例对照组则继续口服恩替卡韦至48 w。两组均随访观察24 w。结果在停药随访24 w时,观察组病毒学复发率为11.7%,生化学复发率为8.3%,黄疸发生率为1.7%,均显著低于对照组的65.0%、43.3%和13.3%(P<0.05);观察组血清HBs Ag和HBe Ag转阴率分别为18.3%和21.7%,而对照组无血清HBs Ag和HBe Ag阴转病例(0.0%和0.0%,P<0.05);观察组血清HBV DNA复阳10例(16.7%),显著低于对照组的42例(70.0%,P<0.05);治疗前,两组血清HBs Ag水平无显著性差异(P>0.05),而在治疗24 w、48 w和停药24 w时,观察组血清HBs Ag水平分别为(1944.7±268.6)IU/ml、(530.7±261.3)IU/ml和(512.4±176.7)IU/ml,均显著低于对照组【(3080.4±255.1)IU/ml、(3087.1±264.1)IU/ml和(3148.5±212.3)IU/ml,P<0.01】。结论针对长期口服恩替卡韦治疗有停药要求的CHB患者,在给予人干扰素α2b巩固治疗后,可在严密观察下停药,临床预后比较好。更多还原

【Abstract】 Objective To evaluate the clinical efficacy and safety of switching from entecavir to interferon-αin patients with chronic hepatitis B(CHB).Methods A total of 120 patients with CHB long-term treated by oral entecavir were recruited in this study who had wished to discontinue the regimen.Out of them,60 received recombinant interferon alpha 2 b for 48 weeks with 12 week oral entecavir combination,and another 60 continued oral entevavir for 48 weeks.All the patients were followed-up for 24 weeks.Results At the end of 24 w followed-up,the viral rebound rate in interferon alpha 2 b-treated patients was 11.7%,serum ALT rebound rate was 8.3%,and elevated serum bilirubin level was 1.7%,significantly lower than 65.0%,43.3% and 13.3%(P <0.05) in entevavir-treated patients;serum HBs Ag and HBe Ag negative rates were 18.3% and 21.7%,while there was no serum HBs Ag and HBe Ag negative occurred(0.0% and 0.0%,P<0.05) in entevavir-treated patients;serum HBV DNA re-positive in 10 cases(16.7%),much lower than in 42 cases(70.0%,P<0.05) in entevavir-treated patients;at the time of recruitment,there was no significantly difference as respect to serum HBs Ag levels in the two groups(P>0.05),while at 24 w,48 w treatment and at the end of 24 w followed-up,serum HBs Ag levels in interferon-α2 b-treated group were(1944.7 ±268.6) IU/ml,(530.7 ±261.3) IU/ml and(512.4 ±176.7) IU/ml,much lower than 【(3080.4±255.1) IU/ml,(3087.1±264.1) IU/ml and(3148.5±212.3)IU/ml,P<0.01】 in entevavir-treated patients.Conclusions It might be feasible to safely stop nucleos(t)ide analogues treatment in CHB patients who have received long-term antiviral treatment and respond viralogically and biochemically properly,and serum HBs Ag levels might be a good parameter for determination of continuing or stopping the regimen.更多还原