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目的分析聚乙二醇干扰素α(PegIFN-α)治疗HBeAg阳性慢性乙型肝炎(CHB)疗效的预测因素。方法对70例HBeAg阳性CHB患者予标准剂量PegIFN-α-2a或PegIFN-α-2b治疗。将治疗48周时,肝功能恢复正常、HBV DNA低于检测下限(<103copies/ml)、伴或不伴HBeAg和/或HBsAg的血清转换者定义为应答组(43例),其余为无应答组(27例)。结果应答组患者基线ALT较高(≥5×ULN)、HBV DNA载量较低(<10~6 copies/ml)、HBsAg水平较低(<5000IU/ml)和HBeAg水平较低(<500S/CO)者的比例高于无应答组(P<0.01)。应答组出现快速病毒学应答率69.8%(30/43),高于无应答组的48.1%(13/27)(P<0.01)。治疗12周时,HBsAg滴度下降幅度预测疗效的灵敏度为65.1%,特异度为92.6%。基线ALT≥5×ULN和12周时HBV DNA是影响预后的独立危险因素。结论基线ALT、HBsAg、HBeAg、HBV DNA水平和治疗12周时的HBV DNA和HBsAg下降幅度对PegIFN-α治疗HBeAg阳性CHB患者的疗效有预测意义。
Objective To analyze the predictors of the efficacy of peginterferon alfa (PegIFN-α) in the treatment of HBeAg-positive chronic hepatitis B (CHB). Methods Seventy patients with HBeAg-positive CHB were treated with standard dose of PegIFN-α-2a or PegIFN-α-2b. At 48 weeks of treatment, liver function returned to normal, HBV DNA was below the detection limit (<103 cops / ml), seroconversion with or without HBeAg and / or HBsAg was defined as the response group (n = 43) Group (27 cases). Results Patients in the responder group had higher baseline ALT (≥5 × ULN), lower HBV DNA load (<10 ~ 6 copies / ml), lower HBsAg levels (<5000 IU / ml) and lower HBeAg levels CO) were higher than non-responders (P <0.01). The rapid virological response rate in response group was 69.8% (30/43), which was higher than that in non-responder group (48.1%, 13/27) (P <0.01). After 12 weeks of treatment, the sensitivity and specificity of predicting the therapeutic effect of HBsAg titers were 65.1% and 92.6% respectively. Baseline ALT≥5 × ULN and HBV DNA at 12 weeks were independent risk factors for prognosis. Conclusions The baseline levels of ALT, HBsAg, HBeAg, HBV DNA and the reduction of HBV DNA and HBsAg at 12 weeks of treatment are predictive for the efficacy of PegIFN-α in the treatment of HBeAg-positive CHB patients.