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目的评估基线HBs Ag定量值对聚乙二醇干扰素α-2b(PEG-IFNα2b)治疗HBe Ag阳性慢性乙型肝炎病毒学应答的预测作用。方法对55例PEG-IFNα2b治疗的HBe Ag阳性慢性乙型肝炎患者分别采用Taqman荧光定量PCR、雅培i2000 HBs Ag试剂动态检测血清基线、治疗期间HBV DNA载量或HBs Ag滴度。评估HBs Ag定量值对PEG-IFNα2b治疗HBe Ag阳性慢性乙型肝炎病毒学应答的预测作用。结果经PEG-IFNα2b单药治疗48周后,HBs Ag基线>20 000 IU/m L(A组)的患者18例,获得病毒学应答(VR)率16.67%;1 500~20 000 IU/m L(B组)的26例,获得VR应答率42.31%;<1 500 IU/m L(C组)11例,获得VR应答率63.64%。A组与C组间比较,差异有统计学意义(P<0.05)。治疗12周log10HBs Ag下降值大于0.5组与小于0.5组间取得VR与SVR(持续性病毒应答)的阴转率比较,差异均无统计学意义(P>0.05);log10HBs Ag下降值>1.0组与<1.0组间取得VR与SVR的阴转率比较,差异均无统计学意义(P>0.05)。A组18例中,有16例经PEG-IFNα2b单药治疗24~48周,HBV DNA仍为阳性。结论 HBs Ag基线水平联合HBV DNA定量可能成为一个有效的预测指标,对优化PEG-IFNα2b HBe Ag阳性慢性乙型肝炎的治疗有一定的指示意义。
Objective To assess the predictive value of baseline HBsAg quantification for the virological response to peginterferon alfa-2b (PEG-IFNα2b) in HBeAg-positive chronic hepatitis B patients. Methods Fifty-five patients with HBeAg-positive chronic hepatitis B treated with PEG-IFNα2b were respectively treated with Taqman real-time PCR and Abbott i2000 HBs Ag reagent. Serum HBV DNA or HBsAg titer during treatment were detected dynamically. To assess the predictive value of HBsAg quantification in virological response to PEG-IFNα2b in the treatment of HBeAg-positive chronic hepatitis B virus. Results After 48 weeks of treatment with PEG-IFNα2b monotherapy, virological response (VR) rate was 16.67% in 18 patients with baseline HBsAg> 20 000 IU / m L (group A), and between 1 500 and 20 000 IU / m The response rate of VR was 42.31% in 26 cases of L (group B) and 11 cases of <1 500 IU / m L (group C). The response rate of VR was 63.64%. A group and C group, the difference was statistically significant (P <0.05). There was no significant difference in the negative conversion rate of VR and SVR (persistent virus response) between the log10HBs Ag values of more than 0.5 and less than 0.5 at 12 weeks of treatment (P> 0.05), and the values of log10HBs Ag> 1.0 There was no significant difference in the negative conversion rate between VR and SVR (P> 0.05). Of the 18 patients in group A, 16 were treated with PEG-IFNα2b monotherapy for 24-48 weeks and HBV DNA was still positive. Conclusion The combination of baseline HBsAg level and HBV DNA quantification may be an effective predictor for the treatment of PEG-IFNα2b HBeAg-positive chronic hepatitis B.