聚乙二醇化干扰素α-2a对拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者的疗效

摘要

目的 探讨拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者,接受聚乙二醇化干扰素α-2a(PEGIFNα-2a)序贯治疗的临床疗效.方法 对22例经拉米夫定治疗失败的HBeAg阳性慢性乙型肝炎患者,在继续使用拉米夫定的情况下,加用PEGIFNα-2a 180 μg,每周1次,联用12周,然后停用拉米夫定,单用PEGIFNα-2a至48周,每月检查1次肝功能、血常规;每3个月检查乙型肝炎病毒(HBV)血清标志物及HBV DNA定量;治疗结束后随访48周.结果 HBV DNA基线平均表达水平为(6.54±0.90)copies/mL(log10).在治疗结束后,有40.91%(9/22)的患者实现HBeAg血清转换和HBV DNA血清表达水平减少,13.64%(3/22)的患者实现HBsAg血清转换.随访48周,36.36%(8/22)的患者维持HBeAg血清转换和HBV DNA水平的降低,在维持HBeAg血清学转换的8例患者中,有2例患者持续维持HBsAg血清转换.结论 PEGIFNα-2a能部分明显降低拉米夫定治疗失败患者的HBV DNA水平,促进HBe Ag和HBs Ag的血清学转换.%Objective To observe the clinical effect of pegylated interferon alfa-2a sequential therapy in the patients with lamivudine-resistant HBeAg-positive chronic hepatitis B (CHB) .Methods A total of 22 patients with lamivudine-resistant HBeAg-posi-tive chronic hepatitis were included in the study .Under the continuous use of lamivudine(100 mg ,once daily) ,all patients received peginterferon alfa-2a 180 g ,once weekly for 12 weeks .Then lamivudine was discontinued and peginterferon alfa-2a as monotherapy was used till 48 weeks .Responses were measured once every 12 weeks after treatment ,including HBsAg , HBeAg seroconversion and HBV DNA suppression .The liver function and blood routine test were examined once every 4 weeks .Results Mean HBV DNA level at baseline was (6 .54±0 .90)copies/mL(log10) .At the end of treatment ,40 .91% (9/22) of the patients had HBeAg seroconversion and the decreased serum expression level of HBV DNA ,and 13 .64% (3/22) of the patients had HBsAg seroconversion ,respectively .During 48-week follow up,the sustained HBeAg seroconversion and the decrease of HBV DNA level were a-chieved in 36 .36% (8/22) of the patients .Among 8 cases of the sustained HBeAg seroconversion ,2 cases sustained HBsAg seroconversion .Conclusion Peginterferon alfa-2a can decrease the level of HBV DNA partially and obviously ,and promote the HBeAg and HBsAg seroconversion in the patients with lamivudine-resistant HBeAg-positive CHB .