Effect of entecavir combined with pegylated interferon in patients with chronic hepatitis B
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摘要:目的 探讨恩替卡韦联合聚乙二醇干扰素治疗对慢性乙型肝炎(CHB)患者的谷丙转氨酶(ALT)复常率、乙型肝炎E抗原(HBeAg)转阴率及乙型肝炎E抗体(HBeAb)转换率的影响。方法 选取120例CHB患者均分为2组，均予以基础治疗，对照组采用聚乙二醇干扰素治疗，观察组采用恩替卡韦联合聚乙二醇干扰素治疗。观察并比较2组患者治疗后不同时点的ALT复常率、HBeAg转阴率、HBeAb转换率、病毒学突破率及治疗期间不良反应发生情况。结果 观察组临床疗效总有效率显著高于对照组(P < 0.05); 治疗6、12、24周后, 2组血清ALT水平均较治疗前显著改善(P < 0.05), 但2组间血清ALT水平差异无统计学意义(P>0.05); 治疗12、24周后，观察组ALT复常率、HBeAg转阴率、HBeAb转换率均显著高于对照组(P < 0.05); 观察组治疗12、24周后病毒学突破率均显著低于对照组(P < 0.05); 2组治疗24周后Th1/Th2型细胞因子水平均较治疗前显著改善(P < 0.05); 观察组治疗24周后INF-γ、IL-6均显著优于对照组(P < 0.05)。结论 恩替卡韦联合聚乙二醇干扰素治疗CHB患者疗效良好，可有效抑制乙型肝炎病毒复制，协同发挥抗病毒作用，安全性高。
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关键词:
- 慢性乙型肝炎 /
- 恩替卡韦 /
- 聚乙二醇干扰素 /
- 谷丙转氨酶复常率 /
- 乙型肝炎E抗原转阴率 /
- 乙型肝炎E抗体转换率
Abstract:Objective To investigate the effect of entecavir combined with pegylated interferon on normalization rate of glutamic-pyruvic transaminase(ALT), clearance rate of hepatitis B E antigen (HBeAg) and conversion rate of hepatitis B E antibody (HBeAb) in patients with chronic hepatitis B(CHB).Methods A total of 120 patients with CHB were divided into two groups, both groups were treated with basic therapy. The control group was treated with pegylated interferon, and the observation group with entecavir combined with pegylated interferon. The ALT normalization rate, clearance rate of HBeAg, conversion rate of HBeAb and viral breakthrough rate of the two groups were observed and compared. At the same time, the adverse reactions during the treatment were observed.Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group(P < 0.05); the serum ALT levels of the two groups after 6, 12 and 24 weeks of treatment were significantly improved compared with treatment before(P < 0.05), but the between-group differences were not observed (P>0.05); after 12 and 24 weeks of treatment, the normalization rate of of ALT, clearance rate of HBeAg and conversion rate of HBeAb in the observation group were significantly higher than those in the control group (P < 0.05); after 12 and 24 week of treatment, the viral breakthrough rate in the observation group was significantly lower than that in the control group(P < 0.05); after 24 week of treatment, the levels of Th1/Th2 cytokines in both groups were significantly improved compared with before treatment(P < 0.05); after 24 week of treatment, INF-γ and IL-6 levels in the observation group were significantly better than those in the control group(P < 0.05).Conclusion Entecavir combined with pegylated interferon in the treatment of CHB patients has better clinical efficacy, which can effectively inhibit HBV replication, and has higher safety and synergistic antiviral effect. -
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表 1 2组患者治疗疗效比较[n(%)]
组别 n 无效 有效 显效 总有效 对照组 60 15(25.00) 27(45.00) 18(30.00) 45(75.00) 观察组 60 6(10.00) 31(51.67) 23(38.33) 54(90.00)* 与对照组比较, *P < 0.05。 
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表 2 2组患者生化指标血清ALT水平比较(x±s)
U/L 组别 n 治疗前 治疗6周后 治疗12周后 治疗24周后 对照组 60 199.15±4.96 124.11±7.13* 48.72±3.84* 39.24±4.79* 观察组 60 191.72±7.33 127.32±4.68* 41.66±4.16* 31.4±3.33* ALT: 谷丙转氨酶。与治疗前比较, *P < 0.05。
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表 3 2组患者治疗后ALT复常率、HBeAg转阴率、HBeAb转换率及病毒学突破率比较[n(%)]
组别 时点 ALT复常 HBeAg转阴 HBeAb转换 病毒学突破 对照组(n=60) 治疗6周后 16(26.67) 20(33.33) 14(23.33) 2(3.33) 治疗12周后 21(35.00) 26(43.33) 20(33.33) 4(6.67) 治疗24周后 39(65.00) 32(53.33) 36(60.00) 5(8.33) 观察组(n=60) 治疗6周后 18(30.00) 21(35.00) 15(25.00) 1(1.67) 治疗12周后 27(45.00)* 31(51.67)* 29(48.33)* 2(3.33)* 治疗24周后 55(91.67)* 53(88.33)* 41(68.33)* 3(5.00)* ALT: 谷丙转氨酶; HBeAg: 乙型肝炎E抗原; HBeAb: 乙型肝炎E抗体。与对照组比较, *P < 0.05。
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表 4 2组患者Th1/Th2型细胞因子水平比较(x±s)
IU/mL 组别 时点 INF-γ TNF-α IL-4 IL-6 对照组(n=60) 治疗前 27.54±3.21 9.48±6.04 20.97±19.34 8.52±5.54 治疗24周后 18.60±1.98 6.75±4.52 31.74±15.90 14.76±6.29 观察组(n=60) 治疗前 27.45±3.17 8.59±5.13 21.63±16.20 7.88±6.45 治疗24周后 15.42±2.16* 5.48±4.56 36.25±13.43 17.92±4.76* INF-γ: 干扰素-γ; TNF-α: 肿瘤坏死因子α; IL-4: 白细胞介素-4; IL-6: 白细胞介素-6。与对照组比较, *P < 0.05。
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