临床肝胆病杂志2018，Vol.34Issue(5)：995-1000,6.DOI:10.3969/j.issn.1001-5256.2018.05.014
聚乙二醇干扰素α-2a初治HBeAg阳性慢性乙型肝炎患者的效果及预测因素分析
Clinical effect of pegylated interferon α-2a in treatment of previously untreated HBeAg-positive chronic hepatitis B patients and related predictive factors
摘要
Abstract
Objective To investigate the clinical effect of pegylated interferon α-2a (PEG-IFNα-2a) in the treatment of previously untreated HBeAg-positive chronic hepatitis B (CHB) patients and related predictive factors.Methods A retrospective analysis was performed for 111 previously untreated HBeAg-positive CHB patients who were treated with PEG-IFNα-2a in Department of Hepatology in the Second Affiliated Hospital of Anhui Medical University from January 2011 to June 2015.The patients were followed up for serum HBsAg quantitation,HBeAg quantitation,HBV DNA quantitation,and alanine aminotransferase (ALT) level at baseline and at weeks 12,24,and 48 of treatment.At week 48 of treatment,of all 111 patients,35 achieved HBeAg seroconversion (48-week seroconversion group) and 76did not achieve such seroconversion (48-week non-seroconversion group).The independent samples t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups.The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of related indices in predicting treatment outcomes,and the area under the ROC curve (AUC) was compared to evaluate the predictive value of each index.The dichotomous logistic regression model was used to evaluate the influence of independent variables on HBeAg seroconversion.Results There was a significant difference in HBeAg level between the two groups before treatment (t =-3.361,P ＜ 0.05).At week 12 of treatment,there were significant differences between the two groups in HBsAg quantitation (t =-3.225,P ＜ 0.05),reduction in HBsAg (Z =-2.202,P ＜ 0.05),HBeAg quantitation (Z =-5.025,P ＜ 0.05),reduction in HBeAg (Z =-3.569,P ＜ 0.05),HBV DNA quantitation (Z =-3.261,P ＜ 0.05),and reduction in HBV DNA (t =2.202,P ＜ 0.05).At week 24 of treatment,there were significant differences between the two groups in HBsAg quantitation (t =-3.222,P ＜ 0.05),reduction in HBsAg (Z =-1.860,P ＜ 0.05),HBeAg quantitation (Z =-5.951,P ＜ 0.05),reduction in HBeAg (t =5.514,P ＜ 0.05),HBV DNA quantitation (Z =-2.311,P ＜ 0.05),and ALT level (Z =-2.234,P ＜ 0.05).HBeAg quantitation at week 24 had a high predictive value (AUC =0.88,P ＜ 0.001),with a sensitivity of 94.03％,a specificity of 64.52％,a positive predictive value of 85.10％,and a negative predictive value of 83.30％ at a cut-off value of 0.18 log10 S/CO.In addition,HBeAg quantitation at week 12 and reduction in HBeAg at week 24 had a good predictive value (AUC =0.81 and 0.80,respectively).Baseline HBeAg ＜ 2.91 log10S/CO (odds ratio [OR] =10.086,95 ％ confidence interval [CI]:1.64-61.93,P =0.013),ALT ＜ 1.45 x upper limit of normal (ULN) at week 24 (OR =5.228,95％ CI:1.27-21.45,P =0.022),and reduction in HBeAg ＞ 1.5 log10 S/CO at week 24 (OR =5.780,95％ CI:1.38-24.25,P =0.016) were independent predictive factors for HBeAg seroconversion at week 48.Conclusion Baseline HBeAg level,HBsAg/HBeAg/HBV DNA levels and reductions at week 12 of treatment,HBsAg/HBeAg levels and reductions at week 24 of treatment,and HBV DNA and ALT levels at the same time points have a certain value in predicting HBeAg seroconversion at week 48.关键词
肝炎,乙型,慢性/聚乙烯二醇类/干扰素类/肝炎e抗原,乙型/治疗结果Key words
hepatitis B, chronic/polyethylene glycols/interferons/hepatitis B e antigens/treatment outcome分类
医药卫生引用本文复制引用
娄鑫,郜玉峰,叶珺,王殷秋,管子妹,邹桂舟..聚乙二醇干扰素α-2a初治HBeAg阳性慢性乙型肝炎患者的效果及预测因素分析[J].临床肝胆病杂志,2018,34(5):995-1000,6.基金项目
安徽省自然科学基金(1608085MH164) （1608085MH164）
