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[目的]探究HBeAg阳性慢性乙型肝炎(CHB)患儿应用聚乙二醇干扰素(PEG-IFN)α-2a治疗的效果。[方法]选取60例于2013年4月~2015年4月入我院诊治的CHB患儿,年龄≤6岁患儿划为小龄组(32例),年龄>6岁划为大龄组(28例),采用PEG-IFNα-2a对患者进行治疗,视患者病情设定疗程(24~72周不等),分别在治疗前、治疗第4、12、24、52、72及治疗后第12、24周检测患者ALT、HBV DNA、HBV血清学标志物等指标,并在不同时间点对2组患者的生化学、病毒学、血清学应答进行对比。[结果]2组患者的生化学、病毒学应答在各时间点无明显差异,差异无统计学意义(P>0.05);治疗第24周小龄组的HBsAg转阴率(40.63%)大于大龄组(7.14%),差异有统计学意义(χ~2=7.23,P<0.01);治疗第52周,小龄组和大龄组HBsAg定量水平分别降至(129.18±79.08)IU/ml和(229.55±54.17)IU/ml,和治疗前水平相比,前者降幅显著大于后者(P<0.05),治疗第72周,2组HBsAg定量水平继续下降至(51.77±31.49)IU/ml和(167.14±47.68)IU/ml,前者降幅显著高于后者(P<0.05);2组的HBV DNA转阴率、HBeAg转阴率和血清学转换率、HBsAg清除率和血清学转换率在治疗第52周均有不同程度下降,但差异无统计学意义(P>0.05)。停药患儿随访期间病情无一复发。血象改变、轻度乏力、流感样症状是常见不良反应。[结论]CHB患儿应用PEG-IFNα-2a治疗的疗效与患儿年龄和疗程有关,患儿年龄越低,HBsAg定量水平下降越明显,HBsAg转阴率越高,疗程越长,疗效越明显。PEG-IFNα-2a是治疗小儿CHB的有效药物,治疗期间监测HBsAg定量水平对疗效有预测价值。
[Objective] To investigate the effect of pegylated interferon (PEG-IFN) α-2a treatment in children with HBeAg-positive chronic hepatitis B (CHB). [Methods] Sixty children with CHB who were admitted to our hospital from April 2013 to April 2015 were selected. The children younger than 6 years old were classified as young children (32 cases), and the children aged> 6 years as the oldest children 28 cases), the patients were treated with PEG-IFNα-2a, depending on the patient’s condition setting course (ranging from 24 to 72 weeks), respectively, before treatment, treatment 4,12,24,52,72 and after treatment The ALT, HBV DNA and HBV serological markers were detected at 12 and 24 weeks, and the biochemical, virologic and serological responses were compared between the two groups at different time points. [Results] There was no significant difference in the biochemical and virological responses between the two groups at all time points, with no significant difference (P> 0.05). The HBsAg negative rate (40.63%) in the 24-week treatment group was greater than that in the older group 7.14%), the difference was statistically significant (χ ~ 2 = 7.23, P <0.01). At 52 weeks of treatment, the levels of HBsAg in the younger and older groups were decreased to 129.18 ± 79.08 IU / ml and 229.55 ± 54.17) IU / ml, the former decreased significantly more than the latter (P <0.05). At the 72nd week of treatment, the levels of HBsAg in two groups continued to decrease to (51.77 ± 31.49) IU / ml and 47.68) IU / ml, the former decline was significantly higher than the latter (P <0.05); 2 groups of HBV DNA negative rate, HBeAg negative rate and seroconversion rate, HBsAg clearance rate and seroconversion rate in the treatment of 52 Weekly varying degrees of decline, but the difference was not statistically significant (P> 0.05). No patient relapsed during follow-up. Blood changes, mild fatigue, flu-like symptoms are common adverse reactions. [Conclusion] The therapeutic effect of PEG-IFNα-2a in children with CHB is related to children’s age and course of treatment. The lower the age of children, the more significant decrease of the quantitative level of HBsAg, the higher the negative rate of HBsAg, the longer the course of treatment, the more obvious the effect . PEG-IFNα-2a is an effective drug for the treatment of CHB in infants. Monitoring the quantification of HBsAg during treatment has predictive value on the curative effect.