α干扰素治疗慢性乙肝远期疗效的临床研究

目的:观察α干扰素治疗慢性乙型肝炎的远期疗效。方法:对α干扰素治疗的109例慢性乙肝患者和未经过干扰素治疗的95例慢性乙肝患者进行24-126个月（平均70个月）的随访。结果:治疗结束时干扰素治疗组和对照组的HBeAg和HBVDNA阴转率分别为:50.5％/14.7％、52.3％/15.8％,差异有显著性（P<0.01）;随访结束时,两组患者HBeAg和HBVDNA阴转率分别为:68.8％/64.2％、64.2％/62.1％（P>0.05）;重型肝炎、肝硬化、肝细胞癌发生率及病死率两组比较依次为:3.7％/4.2％、10.1％/16.8％、2.8％/2.1％、7.3％/7.3％,均无显著性差异（P<0.05）。50％病情恶化患者HBeAg和/或HBVDNA仍为阳性。82.6％的肝硬化、肝细胞癌患者血清存在HBV前C区1896位点和/或其启动子T1762A1764双位点变异。结论:α干扰素对HBV的复制有一定的抑制作用,可加速乙肝患者HBeAg自然阴转过程,但单一、短程α干扰素治疗未能降低重型肝炎、肝硬化、肝细胞癌的发病率及病死率。

Clinic Study of Long-term Follow-up of Chronic Hepatitis B Patients Treated with Interferon Alfa

Objective: To study the long-term effect of Interferon-atreating chronic hepatitis B(CHB) . Methods: 109 patients with CHB treated with IFN-Ain doses of 3Mu every other day for 12 weeks were followed up for 24 - 126 months (mea (50.0%)and 57(52.3% )responded to the therapy with loss of hepatitis Be antigen and viral D n, 70months) .95 patients without anti viral therapy served as control. Results: Among the 109 patients, 55NA from serum. The serum conversion rates of HBeAg and HBV-DNA in IFN-atreated patients were significantly greater than that of control group,50. 5% vs 14.7%and 52.3% vs 15 .8% , P < 0.01 at the end of the treatment. But the serum conversion rates were not significantly different(68 .8% vs 64.2% , 64 .2% vs 62.1 % )at the end of follow-up. The occurrence rates of th hepatic failure, cirrhosis, hepatocellular carcinoma(HCC)and mortality in the IFN-αtreated patients were not significantly different from that of control :3 .7% vs 4.2% , 10.1 % vs 16. 8% , 2 . 8% vs 2.1 % ,7 .3% vs 7 .3% ( P > 0.05) . About half of the patients who developed severe liver complications remained positive of HBeAg and HBV-DNA. The dedective rates of HBV-mutation at pre-c(1896 G-A)and core promoter (T1762 A1764)in patients with cirrhosis and HCC(82.6%) were significantly higher than that of patients with CHB 41.2%( P < 0.05). Conclusion: IFN-ainhibited the replication of HBV, improved liver founctions, may speed the spontaneous seroconvesrsion of HBeAg and HBV-DNA, IFN-atherapy alone (3Mu, 12weeks )did not seem to reduced the occurrence of hepatic failure, cirrhosis and HCC in patients with CHB.