干扰素联合核苷（酸）类似物治疗慢性乙型肝炎的疗效观察

目的观察干扰素（IFN）与核苷（酸）类似物联合治疗慢性乙型肝炎的疗效。方法选择慢性乙型肝炎病例207例,分别予聚乙二醇干扰素（PEG-IFNα-2a或IFNα-2b）治疗52周,随访24周,其中146例（A组）初始24周联合核苷（酸）类似物治疗（59例联合拉米夫定,56例联合阿德福韦酯,31例联合恩替卡韦）,另61例单用IFN治疗（B组）。结果 A、B组治疗结束时HBV DNA阴转率分别为86.3%（126/146）、65.6%（40/61）;ALT复常率87.7%（128/146）、76.5%（39/61）;HBeAg阴转率分别为69.3%（70/101）、40%（10/25）;HBsAg阴转率分别为30.1%（44/146）、16.4%（10/61）;抗-HBs阳转率分别为26.7%（39/146）、11.5%（7/61）,差异均有统计学意义（P〈0.05）。结论 IFN联合核苷（酸）类似物治疗慢性乙型肝炎的疗效优于单用IFN组。

Therapeutic efficacy of combination therapy with interferon and a nucleoside analogue for treating chronic hepatitis B patients

Objective To observe the therapeutic efficacy of combination therapy with interferon（IFN） and a nucleoside analogue for treating chronic hepatitis B（CHB） patients.Methods Two-hundred-and-seven patients diagnosed with CHB were assigned to the following treatment groups：IFN in combination with a nucleoside analogue（group A）;IFN monotherapy（group B）.The patients in group A were further divided into three combination treatment sub-groups,according to the particular nucleoside analogue administered：lamivudine（LAM;sub-group A1,n=59）;adefovir dipivoxil（ADV;sub-group A2,n=56）;and entecavir（ETV;sub-group A3;n=31）.All of the patients received pegylated-IFN（either IFN-2a or IFN-2b） for 52 weeks.The patients in group A received the combination therapy with nucleoside analogue immediately upon initiation of the IFN treatment and lasting for a total of 24 weeks,after which IFN monotherapy was carried out.Results In groups A and B,respectively,86.3% and 65.6% achieved undetectable levels of HBV DNA at the end of treatment.However,group A achieved a higher rate of alanine aminotransferase（ALT） normalization rate（87.7% vs.group B：76.5%,P0.05）.Group A also achieved a significantly higher rates of hepatitis B e antigen（HBeAg） clearance（69.3% vs.group B：40%,P0.05）,hepatitis B surface antigen（HBsAg） clearance（30.1% vs.group B：16.4%,P0.05）,and HBsAg seroconversion（26.7% vs.group B：11.5%,P0.05）.Conclusion The combination treatment of IFN plus a nucleoside analogue is more efficacious than IFN monotherapy for treating CHB patients.