摘要
目的探讨聚乙二醇干扰素a-2a(PEG-IFNa-2a)和恩替卡韦(EVT)治疗HBeAg阳性慢性乙型肝炎的临床疗效及血清学转换预测因素。方法回顾性分析2010年2月至2015年2月收治的141例HBeAg阳性慢性乙型肝炎患者的临床资料。其中采用PEG-IFNa治疗者44例(PEG-IFNa-2a组),采用恩替卡韦(EVT)治疗者67例(EVT组)。观察治疗前及治疗12、24、48周HBeAg定量、HBV DNA定量及丙氨酸氨基转移酶(ALT)水平,记录治疗48周时HBeAg阴转率及血清学转换率、HBVDNA阴转率、ALT复常率。采用ROC曲线分析两组12、24周指标对48周HBeAg血清学转换率的预测价值。结果治疗48周时,两组的HBeAg水平比较差异无统计学意义(P>0.05);PEG-IFNa-2a组及EVT组的HBeAg阴转率分别为9.09%和10.45%,差异无统计学意义(P>0.05);HBeAg血清学转换率分别为34.09%和11.94%,HBV DNA阴转率分别为52.27%和82.09%,PEG-IFNa-2a组的HBeAg阴转率和HBeAg血清学转换率均明显高于EVT组,差异具有统计学意义(P<0.05);PEG-IFNa-2a组及EVT组的ALT复常率分别为68.18%和76.12%,差异无统计学意义(P>0.05)。PEG-IFNa-2a组ROC曲线分析结果:24周时HBeAg水平较基线下降大于97.34%(AUC=0.865、P=0.008),其48周时血清学转换敏感度和特异度分别为0.798和0.843;24周时HBeAg水平较12周下降大于43.26%(AUC=0.812、P=0.009),其48周时血清学转换敏感性和特异性分别为0.812和0.745。结论对于HBeAg阳性慢性乙型肝炎,PEG-IFNa-2a治疗48周较ETV有更高的血清学转换率。PEGIFNa-2a治疗12、24周时HBeAg水平下降程度对48周时的HBeAg血清学转换具有预测价值。
Objective To explore curative effect of pegylated interferons a-2a（ PEG-IFNa-2a） and entecavir（ EVT） in the treatment of HBeAg positive chronic hepatitis B and the forecast factors analysis of the serological conversion. Methods Clinical data of 141 cases of HBeAg positive chronic hepatitis B patients from February 2010-February 2015 were retrospectively analyzed,including 44 cases of patients received the PEG-IFNa-2 a treatment（ PEG-IFNa-2 a group）,67 cases of patients received the entecavir treatment（ EVTgroup）. The HBeAg,HBV DNA quantitative and ALT level before treatment and 12,24,48 weeks after treatment were observed,HBeAg negative-transferring rate and serological conversion rate,HBVDNA negative-transferring rate,ALT normalizing rate at the time of 48 weeks were recorded. ROC curve analysis was performed to analyze the value of the index in predicting of the HBeAg serological conversion rate. Results 48 weeks after the treatment,the HBeAg levels of the two groups had no statistically significant differences（ P〈0. 05）. The HBeAg negative-transferring rate of the PEG-IFNa-2 a group and EVT group respectively was 9. 09% and 10. 45%,there was no statistically significant difference（ P〈0. 05）.HBeAg seroconversion conversion rate respectively was 34. 09% and 11. 94%,with statistically significant difference（ P〈0. 05）; HBVDNA negative-transferring rate respectively was 52. 27% and 82. 09% with statistically significant difference（ P〈0. 05）. ALT normalizing rate respectively was 68. 18% and 76. 12%,which had no statistically significant difference（ P〈0. 05）. ROC curve analysis results of PEG-IFNa-2 a group： HBeAg levels of 24 weeks decreased more than 97. 34% compared with the baseline（ AUC = 0. 865,P = 0. 008）,its 48 weeks seroconversion sensitivity and specificity respectively was 0. 798 and 0. 843; HBeAg levels of 24 weeks decreased more than 43. 26% compared with 12weeks（ AUC = 0. 812,P = 0. 009）,its 48 weeks seroconversion sensitivity and specificity respectively was 0. 812 and 0. 745. Conclusion The serological conversion rate at 48 weeks of PEG-IFNa-2a in the treatment of HBeAg positive chronic hepatitis B was higher than ETV. The decline degree of HBeAg levels at 12,24 weeks have predictive value in HBeAg seroconversion of 48 weeks.
作者
刘海
LIU Hai(Infectious Diseases, The First People s Hospital of Yibin City, Yibin Sichuan 644000 , China)
出处
《临床和实验医学杂志》
2017年第9期883-886,共4页
Journal of Clinical and Experimental Medicine
