聚乙二醇干扰素α-2a治疗慢性乙型肝炎临床分析

目的观察聚乙二醇干扰素（PEG-IFN）α-2a治疗慢性乙型肝炎患者抗病毒的疗效及影响抗病毒疗效的因素。方法将85例丙氨酸转氨酶（ALT）〉2×正常值上限（ULN）的慢性乙型肝炎患者分成乙型肝炎病毒e抗原（HBeAg）阳性组和HBeAg阴性组。给予PEG-IFNu-2a 180μg皮下注射，每周1次，疗程12个月，3个月无治疗应答者停药，观察治疗结束时及治疗结束后6、12、18、24个月时ALT水平，乙型肝炎病毒（HBV）DNA载量对治疗应答的影响。结果①HBeAg阳性组患者治疗结束时的完全应答率及停药后6、12、18、24个月的完全应答率与HBeAg阴性组患者相似，差异无统计学意义。②两组患者治疗前ALT〉5×ULN者治疗结束时的完全应答率与ALT〉（2～5）×ULN者比较，差异有统计学意义。③治疗前HBVDNA栽量水平（低、中、高3个组），HBeAg阳性组和HBeAg阴性组患者治疗结束时的完全应答率，差异无统计学意义。结论PEG-IFNa-2a对HBeAg阳性和HBeAg阴性的慢性乙型肝炎患者均有较好的治疗应答，血清ALT〉5×ULN的患者，PEG-IFNa-2a治疗的疗效好。

Clinical study of peg-interferon-alpha 2a antiviral therapy in patients with chronic hepatitis B

Objective To study the response of peg-interferon-alpha 2a antiviral therapy in patients with chronic hepatitis B（CHB）. Methods Eighty-five CHB patients with serum ALT values higher than 2 × the upper limit of the normal（ULN） were divided into HBeAg-positive and HBeAg-negative group. All patients were treated with peginterferon-alpha 2a by subcutaneous injection（180 μg once weekly,with 12 month therapy）. After treatment for three months, patients without a defined therapeutic response were dropped from the treatment group. The sustained response and the antiviral effect of the treatment were assessed at tht end of the therapy. To investigate the possible impact factors of the response to peg-interferon-alpha 2a,the therapeutic response of patients with different serum ALT level and HBV viral load levels were studied. Results （1）There was no statistical difference of the rates of response at the end of treatment and 6,12,18 and 24 months after the cessation of therapy between HBeAg-positive and HBeAg- negative group. （2） The rate of response of patients with serum ALT values〉5 × ULN was significantly higher than that with serum ALT values〈 5 × ULN, between HBeAg-positive and HBeAg-negative group. （3）In both HBeAg- positive and HBeAg-negative groups,no difference existed between the rates of response among patients with different levels of HBV viral loads. Conclusion Similar rates of response and sustained virological response to the peginterferon-alpha 2a treatment can be achieved in both HBeAg-positive and HBeAg-negative patients. High serum HBV viral loads can be considered as predictors of a good therapeutic response.