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目的观察干扰素α(IFNα)个体化治疗HBeAg阳性慢性乙型肝炎患者的临床应答和远期疗效。方法对53例HBeAg阳性慢性乙型肝炎患者,治疗前行肝穿刺病理检查确诊,给予注射用重组人IFNα-1b,50μg、隔日1次、皮下注射。每隔3个月检测血清HBV DNA定量和HBeAg、HBsAg,定量降低者进行延长治疗。治疗结束后于3个月、6个月、1年、3年、5年、7年进行随访。结果 53例HBeAg阳性慢性乙型肝炎接受不同疗程(24～100周)的IFNα-1b,治疗结束时,近期应答者34例,应答率64.15%,疗程48～100周。其中完全应答者24例(45.28%),部分应答者10例(18.87%),无应答者19例(35.85%)。三组患者之间年龄和IFNα疗程的差异有统计学意义(P=0.011,P=0.000)。完全应答者中2例患者在疗程68、80周结束时HBsAg阴转(3.77%)。随访期间完全应答组1年内复发1例。部分应答组复发8例:分别在6个月、1年和3年复发3例、4例、1例。结论 IFNα个体化治疗HBeAg阳性慢性乙型肝炎患者,疗程长、年龄小者近期应答率高,完全应答者远期复发率低。
Objective To observe the clinical response and long-term efficacy of interferon α (IFNα) in the treatment of HBeAg-positive chronic hepatitis B patients. Methods Fifty-three HBeAg-positive chronic hepatitis B patients were diagnosed by liver biopsy before treatment. Recombinant human IFNα-1b was injected intraperitoneally at a dose of 50 μg once daily for subcutaneous injection. Serum HBV DNA quantification and HBeAg, HBsAg, quantitative reduction were measured every 3 months for prolonged treatment. Follow-up was performed at 3 months, 6 months, 1 year, 3 years, 5 years and 7 years after treatment. Results 53 cases of HBeAg-positive chronic hepatitis B received IFNα-1b in different courses (24 to 100 weeks). At the end of treatment, 34 cases were recently responded, the response rate was 64.15% and the course of treatment was 48 to 100 weeks. Among them, 24 (45.28%) were complete responders, 10 (18.87%) were partial responders and 19 (35.85%) were nonresponders. There was a statistically significant difference in age and IFNα treatment among the three groups (P = 0.011, P = 0.000). Two of the total responders had HBsAg negative (3.77%) at the end of the course of 68 and 80 weeks. During the follow-up period, the complete response group recurred in 1 case within 1 year. Some patients in response group relapsed in 8 cases: 6 months, 1 year and 3 years recurrence in 3 cases, 4 cases, 1 case. Conclusion IFNα individualized treatment of patients with HBeAg-positive chronic hepatitis B, long course of treatment, the younger the high rate of recent response, long-term recurrence of complete response was low.