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目的 探讨聚乙二醇干扰素(Peg-IFN) α-2a对核苷(酸)类似物在治疗获得部分病毒学应答且HBeAg仍为阳性的慢性乙型肝炎患者的疗效及影响疗效的相关因素.方法 对核苷(酸)类似物在治疗中获得部分病毒学应答且HBeAg仍为阳性的慢性乙型肝炎患者进行Peg-IFN α-2a 180μg每周皮下注射1次治疗;所有患者采用个性化疗程,对Peg-IFN α-2a治疗期间HBsAg和(或)HBeAg持续下降者则继续治疗.患者入组前及Peg-IFN α-2a治疗期间每3个月检测HBV DNA含量和血清学指标.以Peg-IFN α-2a治疗结束时HBsAg消失或血清学转换为主要疗效评价指标,HBsAg 10 IU/ml和HBeAg血清学转换为次要疗效评价指标.组间差异采用x2检验比较.使用受试者工作特征曲线下面积来评估干扰素治疗前基线血清HBsAg水平对干扰素治疗结束时＜10 IU/ml的预测意义.结果 共入组并治疗患者81例,核苷(酸)类似物治疗12.0 (6.0 ～ 24.0)个月.PegIFN α-2a治疗19.6 (15.5 ～ 33.3)个月;8.6 ％(7例)获得HBsAg消失或血清学转换,除HBsAg消失者外,另有17.3％ (14例)达到HBsAg＜10 IU/ml.HBeAg消失率为40.7％,HBeAg血清学转换率为38.3％.基线HBsAg＜1 500 IU/ml预测干扰素治疗结束时HBsAg＜10 IU/ml的受试者工作特征曲线下面积=0.747,敏感度和特异度为87.3％和33.3％;阳性预测值和阴性预测值为82.1％和42.8％. 结论 Peg-IFN α-2a治疗可使经核菅(酸)类似物治疗获得部分病毒应答的HBeAg阳性慢性乙型肝炎的患者获得更高的免疫控制,基线HBsAg水平＜1500 IU/ml可预测Peg-IFN o-2a的疗效.“,”Objective To investigate the efficacy and related factors of pegylated-interferon α-2a (PEG-IFN-2a) treatment in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) who achieved partial viral response with nucleoside analogue (NA) therapy.Methods Patients with HBeAg-positive CHB and partial viral response to NA treatment were administered a PEG-IFN-2a therapy regimen of 180 g subcutaneous injection once weekly for a personlized duration of time.The existing NA therapy was continued in combination with the new PEG-IFN-2a treatment for 12 weeks.Measur-ements of serum HBV DNA load, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), HBeAg and hepatitis B e antibody (anti-HBe) were taken at baseline (prior to addition of the PEG-IFN-2a therapy) and every 3 months afterwards.For determining response to treatment, primary efficacy was defined as undetectable HBsAg and seroconversion, and secondary efficacy was defined as HBsAg ＜ 10 IU/mL and HBeAg seroconversion.Statistical analysis was carried out using SPSS statistical software.Results A total of 81 consecutive patients with an average of 12.0 months (range: 6.0-24.0 months) of NA therapy were included in the study and received an average of 19.6 months (range: 15.5-33.3 months) of PEG-IFN-2a treatment.At the end of PEG-IFN-2a therapy, 7 (8.6％) of the patients achieved undetectable HBsAg and seroconversion, and 14 (17.3％) showed HBsAg ＜ 10IU/mL.In addition, 40.7％ achieved undetectable HBeAg and seroconversion, a rate that was slightly higher than that (38.3％) seen in treatment-naive patients who received PEG-IFN-2a.Statistical analyses suggest that baseline level of HBsAg at ＜ 1500 IU/mL may predict end of PEG-IFN-2a treatment response for HBsAg ＜ 10 IU/mL, as evidenced by the area under the curve measure of 0.747, sensitivity measure of 87.3％, specificity measure of 33.3％, positive predictive value of 82.1％ and negative predictive value of 42.8％.Conclusion Patients with HBeAg-positive CHB and partial viral response to NA therapy can achieve undetectable HBsAg and HBeAg seroconversion after switching to PEG-IFN-2a treatment.Baseline HBsAg level may be predictive ofresponse to this therapeutic strategy.