核苷(酸)类似物序贯干扰素治疗乙型肝炎病毒e抗原阳性慢性乙型肝炎患者的临床观察

目的 观察HBeAg阳性慢性乙型肝炎(CHB)患者在核苷(酸)类似物抗病毒治疗基础上序贯聚乙二醇干扰素α-2a(PEG IFNα-2a)治疗48周血清HBsAg的变化.方法 6例HBeAg阳性CHB患者中,3例采用核苷(酸)类似物序贯PEG IFNα-2a治疗48周,3例维持原核苷(酸)类似物治疗方案,每12周采用实时PCR定量检测HBV DNA,采用时间分辨免疫荧光分析法检测HBsAg、抗-HBs、HBeAg、抗-HBe及抗-HBc.结果 核苷(酸)类似物序贯PEG lFNα-2a治疗48周后,3例序贯治疗患者血清HBsAg均消失,而维持原核苷(酸)类似物治疗患者血清HBsAg效价为100～320 IU/mL.结论 对核苷(酸)类似物治疗产生较好应答反应且伴有血清HBsAg效价明显下降的HBeAg阳性CHB患者,在核苷(酸)类似物抗病毒治疗基础上序贯PEG IFNα-2a治疗48周能有效促进血清HBsAg下降,并出现血清HBsAg消失的现象.

Increase of hepatitis B surface antigen loss rate in hepatitis B e antigen positive chronic hepatitis B patients treated with nucleos (t) ide analogs and pegylated interferon alfa-2a sequential therapy

Objective To investigate the changes of hepatitis B sarfaceantigen (HBsAg) titer in hepatitis B e antigen (HBeAg) positive chronic hepatitis B (CHB) patients treated with nucleos(t)ide analogs and pegylated interferon alfa-2a (PEG IFNα-2a) sequential therapy.Methods Among 6 HBeAg positive CHB patients,3 patients were treated with nucleos(t)ide analogs followed by PEG IFNα-2a for 48 weeks,3 patients were treated with nucleos(t)ide analog monotherapy.The serum HBsAg,anti-HBs,HBeAg,anti-HBe and anti-HBc were detected using the time-resolved immunofluorometric assay and serum hepatitis B virus (HBV) DNA levels were determined by Taqman polymerase chain reaction (PCR) every 12 weeks.Results HBsAg loss were achieved in three patients after 48-week nucleos(t)ide analogs and PEG IFNα-2a sequential therapy.However,the HBsAg titers of another 3 patients varied from 100 IU/mL to 320 IU/mL.Conclusion In HBeAg positive CHB patients who obtain virologic response accompanied with HBsAg titer decreasing dramatically by nucleos(t) ide analog treatment,PEG IFNα-2a sequential treatment can increase HBsAg clearance rate.