【摘要】 目的观察和分析慢性乙型病毒性肝炎(CHB)经重组α干扰素(rIFN-α)治疗取得完全应答后,在长期随访过程中的复发情况,及其影响复发的相关因素。方法523例经肝穿刺活检证实的CHB患者,给予rIFN-α1b治疗,疗程6～25个月,治疗中每1～3个月检测肝功能、HBV DNA、乙肝病毒e抗原(HBeAg)。治疗后随访至少12个月,随访时每3～6个月检查肝功能、HBV DNA、HBsAg及HBeAg。结果523例患者经rIFN-α治疗后,近期应答302例(57.7%)。近期应答者经随访39.2±21.5个月,持续应答183例(35.0%),复发119例(39.4%)。患者年龄、治疗前HBeAg状态、以及随访时间是影响复发的相关因素:复发组平均年龄(34.27±8.69岁)显著高于持续应答组的平均年龄(25.28±8.65)岁(P<0.001);HBeAg(+)组复发率76/225例(33.8%)显著低于HBeAg(-)组43/77例(55.8%)(P<0.001);按随访每12个月为一时间段,分1～12个月、13～24个月、25～36个月、37～48个月、49～60个月和≥61个月6个时间段,各时间段复发的发生率有显著性差异(P<0.001),累计复发率亦有显著性差异(P<0.001),但25个月以后的4个时间段累计复发率差异无显著性(P=0.670)。患者性别、治疗前ALT水平和HBV DNA水平、肝组织炎症活动度(G)、肝纤维化程度(S)及治疗疗程与复发无明显相关性,但在HBeAg(+)组中,复发组的平均基线HBV DNA水平6.98±1.14Log拷贝/ml高于持续应答组6.21±1.04Log拷贝/ml(P=0.017)。结论CHB患者经rIFN-α治疗后,患者年龄、治疗前HBeAg状态以及随访时间是影响其在随访过程中复发的相关因素。在HBeAg(+)CHB中,治疗前HBV DNA水平亦是影响复发的相关因素。更多还原

【Abstract】 Objective To investigate the related to relapse of chronic hepatitis B(CHB)after recombinant interferon-alpha(rIFN-α)treatment.Methods This investigation involved 523 pathologically confirmed CHB patients including 403 HBeAg-positive and 120 HBeAg-negative patients,who were treated with 5 MU rIFN-α subcutaneously thrice a week for 6-25 months.For each patient,serum alanine aminotransferase(ALT)was measured biochemically,serum HBV DNA level detected with quantitative fluorescent PCR,and HBeAg level with enzyme immuoassay every 1-3 months during therapy and every 3-6 months during the follow-up period.Results Early response to rIFN-α treatment was observed in 302(57.7%)patients at the end of treatment,among whom 39.4%(119/302)suffered relapse during the follow-up for 39.2±21.5 months.Age,HBeAg status before treatment,and follow-up duration were the predictive factors for post-treatment relapse.The mean age of patients with CHB relapse was significantly higher than that of the sustained responders(P<0.001),and the relapse rates in HBeAg-negative group(55.8%,43/77)were significantly higher than that in HBeAg-positive group(33.8%,76/225)at the end of follow up(P<0.001).The relapse rate and accumulative relapse rates at each year during the follow-up(for 5 years as the longest)differed significantly(P<0.001,P=0.000),but the accumulative relapse rates differed little between the years after the initial 2 of the follow-up(P=0.670).The relapse was not related to the patient’s gender,pretreatment serum ALT,HBV DNA,grade of liver inflammation,stage of liver fibrosis,or duration of treatment.In HBeAg-positive patients,however,the mean HBV DNA was significantly higher in relapse group than in sustained response group(P=0.017).Conclusion Age,pretreatment HBeAg status,and follow-up duration are independent predictive factors for post-treatment CHB relapse.In HBeAg positive patients,pretreatment serum HBV DNA is also one of the risk factors for relapse.更多还原