聚乙二醇干扰素治疗低水平HBsAg慢性乙肝患者疗效

目的 分析聚乙二醇干扰素（PEg-IFNα-2a、PEg-IFNα-2b）治疗低水平HBsAg慢性乙型病毒性肝炎（CHB）的临床疗效。方法 采用回顾性研究,选取2017年1月1日—2019年1月1日于北京大学深圳医院感染性疾病科门诊就诊,HBsAg<500 IU/mL且开始使用聚乙二醇干扰素治疗的慢性乙型病毒性肝炎患者,分析在治疗第24周、第48周HBsAg清除率及相关疗效影响因素。结果 共纳入88例患者,在0~48周达到HBsAg清除有45例,其中应答组与未应答组性别、HBsAg基线水平差异有统计学意义（P<0.05）;达到HBsAg清除的45例中,24例使用PEg-IFNα-2a治疗,21例使用PEg-IFNα-2b治疗,两组HBsAg清除率差异无统计学意义（P=0.195）;治疗第24周时新增HBsAg清除患者25例,经多因素分析,基线HBsAg水平差异有统计学意义（OR=0.991,95%CI=0.983~1.000,P=0.042）;治疗第48周时新增HBsAg清除患者10例,经多因素分析,第24周HBsAg下降率有统计学意义（OR=1.063,95%CI=1.077~1.123,P=0.027）。结论 聚乙二醇干扰素治疗HBsAg<500 IU/mL慢性乙型病毒性肝炎患者HBsAg 清除率明显高于基线水平高者;PEg-IFNα-2a、PEg-IFNα-2b疗效无差异。治疗过程中第24周HBsAg下降幅度可预测治疗48周时HBsAg清除率。

Efficacy analysis of pegylated interferon in patients with low-level HBsAg chronic hepatitis B

Objective To analyze the clinical cure rate of pegylated interferon (PEg-IFNα-2a, PEg-IFNα-2b) in the treatment of low-level HBsAg chronic hepatitis B(CHB). Methods Chronic hepatitis B patients with HBsAg <500 IU/mL who started treatment with pegylated interferon were selected in the Department of Infectious Diseases,Peking University Shenzhen Hospital from January 1, 2017 to January 1, 2019. HBsAg clearance rate and related influencing factors at 24th week and 48th week of treatment were analyzed. Results Totally 88 patients were included,of which 45 people achieved HBsAg clearance during the observation period (0-48w). There were statistically significant differences in gender and baseline HBsAg levels between the responding and non-responding groups (P<0.05). And 24 were treated with PEg-IFNα-2a, and 21 were treated with PEg-IFNα-2b of the 45 people who achieved HBsAg clearance.There was no statistical difference between the two groups (P = 0.385).Using multivariate analysis for 25 patients with HBsAg clearance at week 24 of treatment,baseline HBsAg levels were statistically significant (OR= 0.991, 95% CI=0.983-1.000, P= 0.042). Using multivariate analysis for 10 patients with HBsAg clearance at week 48 of treatment,the percentage decrease in HBsAg at week 24 was statistically significant（OR=1.063,95%CI=1.077-1.123,P=0.027）. Conclusion Pegylated interferon can obtain significantly higher HBsAg clearance rate in patients with low level HBsAg<500 IU/mL chronic hepatitis B than those with high baseline.There was no difference in the efficacy of PEg-IFNα-2a and PEg-IFNα-2b.Percent decrease in HBsAg at week 24 can predict HBsAg clearance rate at week 48 of treatment.