摘要
目的研究聚乙二醇干扰素α-2b(Peg-IFNα-2b)治疗非活动性乙型肝炎(乙肝)病毒表面抗原(HBsAg)携带者(inactive HBsAg carrier,IHC)的临床结局,探讨此类慢性乙肝特殊人群临床治愈的可能性及其影响因素。方法回顾性研究2016-2019年门诊IHC 107例。其中30例IHC未接受治疗干预作为对照组,77例IHC给予Peg-IFNα-2b作为治疗组,疗程不超过96周。采用单因素和多因素logistic回归分析研究HBsAg清除的相关因素,绘制受试者工作特征 (ROC)曲线评估相关因素对HBsAg清除的预测价值。结果共107例患者纳入研究。治疗48周,治疗组HBsAg清除率、血清学转换率分别为24.7%(19/77)、9.1%(7/77);治疗96周,分别上升为40.3%(31/77)、19.5%(15/77)。对照组在治疗48周及96周HBsAg清除率、血清学转换率均为0(0/30)。治疗组HBsAg清除率、血清学转换率明显高于对照组(P <0.001)。多因素logistic回归分析显示基线HBsAg水平、治疗第12周HBsAg下降值、治疗第13~36周HBsAg下降值、治疗第4周丙氨酸转氨酶(ALT)等因素可能是治疗后HBsAg清除的关键指标(P<0.05)。经ROC曲线分析显示,以上因素的曲线下面积(AUC)分别为0.869、0.868、0.855、0.783,且临界值分别为基线HBsAg <1.96 lg IU/mL、第12周HBsAg下降>0.70 lg IU/mL、第13~36周HBsAg下降>1.20 lg IU/mL、第4周ALT>40.5 U/L。结论用Peg-IFNα-2b治疗IHC可清除部分患者HBsAg,甚至达到HBsAg血清学转换的目的,且基线低水平HBsAg、治疗第12周及第13~36周HBsAg显著下降、第4周ALT升高预示着HBsAg清除的可能。
Objective To analyze the clinical outcome of inactive HBsAg carriers (IHCs) after treatment with Peg-IFNα-2b and the value of serum HBsAg level in predicting efficacy.Methods A total of 107 IHCs were enrolled in this study in our hospital from 2016 to 2019.Thirty patients did not receive antiviral treatment as control group,while 77 patients received Peg-IFNα-2b as treatment group.The total duration of treatment was no more than 96 weeks.Logistic regression analysis was used to analyze the related factors of HBsAg clearance.The receiver operating characteristic (ROC) curve was plotted to assess the value of related factors in predicting HBsAg clearance.Results A total of 107 subjects were included.The HBsAg clearance rate and seroconversion rate were 24.7% and 9.1% after Peg-IFNα-2b treatment for 48 weeks and increased to 40.3% and 19.5% after 96 weeks.HBsAg clearance and HBsAg seroconversion were not achieved in control group at 48 week or 96 weeks (P<0.001).Multivariate logistic regression analysis showed that baseline HBsAg,week 12 HBsAg decline,week 13-36 HBsAg decline,and week 4 ALT were all significant factors for HBsAg clearance (all P<0.05).ROC curve analysis showed that the AUC of the above factors was 0.869,0.868,0.855 and 0.783,respectively.The cutoff values were baseline HBsAg<1.96 lg IU/mL,week 12 HBsAg decline >0.70 lg IU/mL,week 13-36 HBsAg decline >1.20 lg IU/mL,and week 4 ALT>40.5 U/ L.Conclusions High HBsAg clearance and seroconversion rates could be achieved in some IHCs after treatment with PEG-IFN α-2b.HBsAg clearance may be predicted by low baseline HBsAg,week 12 HBsAg decline,week 13-36 HBsAg decline and week 4 ALT elevation.
作者
周淋淋
秦波
ZHOU Linlin;QIN Bo(Department of Infectious Diseases,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2020年第4期374-378,共5页
Chinese Journal of Infection and Chemotherapy
基金
国家自然科学基金(81271838)。
