阿德福韦酯治疗HBeAg阳性慢性乙型肝炎血清学应答的预测因素分析

目的探讨基线血清TNFα、ALT、HBVDNA载量及24周HBV血清学标志物等因素对阿德福韦酯（ADV）治疗HBeAg阳性慢性乙型肝炎（CHB）48周时患者血清学应答的预测价值。方法203例HBeAg阳性CHB患者口服ADV治疗48周，10mg/d。采用ELISA测定HBV血清学标志物和基线血清TNFα水平，荧光定量PCR检测HBVDNA，Logistic回归分析影响HBeAg阳性患者血清学应答的因素。结果203例患者治疗24周时HBV DNA转阴率为31．5％（64／203），ALT复常率为59．1％（120／203），HBeAg转阴率为15．8％（32／203），HBeAg转换率为8．9％（18／203），应答率为13．3％（27／203）；治疗48周时HBV DNA转阴率为58．6％（119／203），ALT复常率为78．3％（159／203），HBeAg转阴率29．6％为（60／203），HBeAg转换率为16．7％（34／203），应答率为25．6％（52／203）。Logistic回归分析发现，48周HBeAg转阴的患者较未转阴者的24周HBV DNA转阴率、HBeAg转阴率及转换率、基线TNFα水平高（P值分别为0．017、0．001、0．029和0．040）；48周HBeAg转换的患者较未转换者的24周HBeAg转换率高，而基线HBVDNA低（P值分别为0．000和0．004）。结论24周HBVDNA转阴率、HBeAg转阴率和转换率，及基线TNFα水平可以预测48周HBeAg转阴率，而24周HBeAg转换率和基线HBV DNA载量可以预测48周HBeAg转换率。

Predictive factors for serological response in HBeAg-positive chronic hepatitis B patients with adefovir dipivoxil treatment

Objective To investigate the predictive value of TNFα, ALT, HBV DNA loads and HBV serologieal market＇s in response to adefovir dipivoxil （ADV） treatment for patients with chronic hepatitis B （CHB）. Methods Two hundred and three HBeAg-positive CHB patients were administered with ADV 10 mg/d for 48 weeks. HBV serological markers and TNFα at the baseline were determined by enzyme linked immunosorbent assay （ELISA）, and HBV DNA loads were detected by PCR. Logistic regression was used to identify predictive factors for serological response at 48th week after the treatment. Results The rates of HBV DNA clearance, ALT normalization, HBeAg loss, HBeAg seroconversion and response at 24th week were 31.5% （64/203） , 59.1% （ 120/203 ）, 15.8% （32/203）, 8.9% （ 18/203 ） and 13.3% （27/203） respectively, while those at 48th week were 58.6% （ 119/203 ）, 78.3 % （ 159/203 ）, 29.6% （60/203）, 16.7% （34/203） and 25.6% （ 52/203 ）, respectively. Patients who achieved HBeAg loss at 48th week were found to have higher rates of HBV DNA clearance, HBeAg loss and seroeonversion at 24th week and higher TNFα at baseline （ P = 0. 017, 0. 001 , 0. 029 and 0. 040） , while those who achieved HBeAg seroconversion at 48th week were found to have higher rate of HBeAg seroeonversion at 24th week, and lower baseline HBV DNA loads （P = 0. 000 and 0. 004）. Conclusion For HBeAg-positive CHB patients with ADV treatment, the rate of HBV DNA clearance, HBeAg loss and seroeonversion at 24th week and TNFα at baseline may be used to predict the rate of HBeAg loss at 48th week; the rate of HBeAg seroeonversion at 24th week and baseline HBV DNA loads may be used to predict the rate of HBeAg seroconversion at 48th week.