聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阳性慢性乙型肝炎患者疗效及对血清细胞因子和肝纤维化指标的影响

目的观察聚乙二醇干扰素α-2a联合阿德福韦酯治疗HBeAg阳性的慢性乙型肝炎（CHB）患者的疗效及其对血清T淋巴细胞因子和肝纤维化指标的影响。方法144例CHB患者依纳入顺序单双号被随机分为观察组和对照组,每组72例。给予对照组患者阿德福韦酯,观察组在对照组的基础上给予聚乙二醇干扰素α-2a,治疗24 w,观察两组抗病毒疗效以及血清T淋巴细胞因子白介素（IL）-2、IL-6、IL-10、γ-干扰素（INF-γ）以及血清肝纤维化指标Ⅲ型前胶原肽（PⅢP）、层粘连蛋白（LN）、透明质酸（HA）、Ⅳ型胶原(Ⅳ-C）的变化。结果在治疗24 w末,观察组患者血清HBV 转阴率、HBeAg转阴率、HBeAg血清转换率分别为72.22%、58.33%和41.67%,显著高于对照组(分别为55.56%、22.22%和20.83%,P<0.05）;观察组血清IL-2和INF-γ水平分别为（2.18±1.26） pg/ml和（99.65±11.03） pg/ml,较对照组显著升高【（1.71±1.05） pg/ml和（85.70±11.82） pg/ml,P<0.05】,而IL-6和IL-10分别为（4.53±2.15） pg/ml和（15.42±9.39） pg/ml,较对照组显著降低【（5.47±2.25） pg/ml和（20.07±13.08）pg/ml,P<0.05】;观察组HA、LN、Ⅳ-C、PⅢP分别为（127.28±59.60） μg/L、（110.52±37.39） μg/L、（116.56±28.61） μg/L和（163.65±64.38） μg/L,均较对照组显著降低【（261.35±81.46） μg/L、（162.32±38.82）μg/L、（174.13±43.05） μg/L和（212.43±64.25） μg/L,P<0.05】。结论聚乙二醇干扰素α-2a联合阿德福韦酯抗病毒疗效及改善HBeAg阳性CHB患者血清T淋巴细胞因子失衡,降低肝纤维化指标的作用优于单用阿德福韦酯者。

Efficacy of pegylated interferon α-2a combined with adefovir dipivoxil and their effects on serum T lymphocyte cytokines and hepatic fibrosis indexes in patients with HBeAg-positive chronic hepatitis B

Objective To observe the efficacy of pegylated interferon α-2a combined with adefovir dipivoxil and their effects on serum T lymphocyte cytokines and hepatic fibrosis indexes in patients with HBeAg-positive chronic hepatitis B（CHB）. Methods 144 patients with CHB were randomly divided into observation group and control group with 72 cases in each group according to the inclusion orders. The patients in control group was given adefovir dipivoxil, and in the observation group was given pegylated interferon α-2a combined with adefovir dipivoxil. After 24-week treatment,the efficacy of treatment,and changes of serum IL-2,IL-10,IL-6 and INF-γ and PⅢP,LN,HA and Ⅳ-C in each group were recorded. Results At the end of 24 weeks of treatment,the negative rates of serum HBV DNA,HBeAg and HBeAg/anti-HBe seroconversion in observation group were 72.22%,58.33% and 41.67%,respectively,much higher than those in the control group（5.56%,22.22% and 20.83%,respectively,P<0.05 for all）;Compared with in control group,serum IL-2 and INF-γ in observation group were much higher （2.18±1.26） pg/ml vs. （1.71±1.05） pg/ml,and （99.65±11.03） pg/ml vs. （85.70±11.82） pg/ml,P<0.05 for both],while serum IL-6 and IL-10 levels were much lower （4.53±2.15） pg/ml vs. （5.47±2.25） pg/ml,and （15.42±9.39） pg/ml vs.（20.07±13.08） pg/ml,P<0.05 for both];Serum hepatic fibrosis indexes in observation group were much lower than those in the control group HA （127.28±59.60） μg/L vs. （261.35±81.46） μg/L,LN （110.52±37.39） μg/L vs. （162.32±38.82） μg/L,Ⅳ-C （116.56±28.61） μg/L vs. （174.13±43.05） μg/L, PⅢ（163.65±64.38） μg/L vs. （212.43±64.25） μg/L,P<0.05 for all]. Conclusion Compared with single use of adefovir dipivoxil,pegylated interferon α-2a combined with adefovir dipivoxil have better antiviral effects and better improvement on T lymphocyte cytokines and hepatic fibrosis indexes in patients with HBeAg-positive chronic hepatitis B.