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目的明确干扰素(interferon,IFN)治疗低水平HBs Ag慢性乙型肝炎患者的临床治愈率、影响因素及最适疗程。方法回顾性分析了2012年1月至2014年8月间在我院感染科门诊接受聚乙二醇干扰素(Peg-IFN)或普通干扰素治疗疗程≥24周、HBs Ag<3 000 IU/m L的慢性乙型肝炎患者74例,获得HBs Ag和HBe Ag清除定义为应答,治疗第24、48、72周依次分析疗效影响因素,采用非参数检验、χ2检验、Logistic回归模型分析应答组与未应答组患者的一般情况、HBV标志物以及治疗过程中各指标变化对HBs Ag清除的影响。结果 74例患者治疗至停药时,25例(33.8%)发生应答,应答组中位基线HBs Ag水平较不应答组低(70.70 IU/m L vs 440.71 IU/m L,P=0.041);Peg-IFN的HBs Ag清除率高于普通IFN(41.9%vs 22.6%,P=0.084)。第12周HBs Ag下降百分数可预测24周疗效(OR=1.058,P=0.010),ROC曲线下面积为0.860,Cut-off值为78.9,敏感性为0.889,特异性为0.815。基线HBV DNA水平和第24周HBs Ag下降百分数可预测48周疗效(OR=9.116,P=0.033;OR=1.089,P=0.006),第24周HBs Ag下降百分数ROC曲线下面积0.870,最佳的Cut-off值为69.7,敏感性为1,特异性为0.722。48周内清除率与治疗时间呈线性正相关,至48周时HBs Ag清除21例,占总应答例数的84.0%(21/25)。结论 IFN治疗基线HBs Ag<3 000 IU/m L病例的临床治愈率明显高于基线水平高者,Peg-IFN略优于普通IFN,疗程建议为48周,治疗12周后可根据当前时间点的HBs Ag下降程度评估后续疗效。
Objective To determine the clinical cure rate, influential factors and the optimal course of interferon (IFN) treatment for chronic hepatitis B patients with low-level HBsAg. Methods A retrospective analysis of the treatment of peg-interferon (IFN-α) or interferon-alpha (IFN-α) in our hospital from January 2012 to August 2014 for ≥24 weeks with HBsAg <3000 IU / 74 patients with chronic hepatitis B were enrolled in this study. HBs Ag and HBe Ag clearance were defined as response. The influencing factors of efficacy were analyzed sequentially at 24, 48 and 72 weeks after treatment. Non-parametric test, χ2 test and Logistic regression model were used to analyze response group And unresponsiveness patients, HBV markers and the changes of HBsAg clearance in the course of treatment. Results Twenty - four patients (33.8%) responded to treatment until discontinuation. The median baseline HBsAg level in the response group was lower than that in the response group (70.70 IU / m L vs 440.71 IU / m L, P = 0.041). The HBsAg clearance of Peg-IFN was higher than that of normal IFN (41.9% vs 22.6%, P = 0.084). The percent reduction of HBs Ag in week 12 was predictive of outcome for 24 weeks (OR = 1.058, P = 0.010). The area under the ROC curve was 0.860, Cut-off was 78.9, and the sensitivity was 0.889. The specificity was 0.815. The baseline HBV DNA level and the percentage of HBsAg decrease at week 24 predicted the efficacy at 48 weeks (OR = 9.116, P = 0.033; OR = 1.089, P = 0.006) Had a cut-off value of 69.7 with a sensitivity of 1 and a specificity of 0.722.4 There was a linear positive correlation between clearance rate and duration of treatment. At week 48, HBsAg was cleared in 21 of 84 (84.0%) patients 21/25). Conclusions The clinical cure rate of HBs Ag <3 000 IU / m L in HBsAg-treated patients with IFN was significantly higher than that of baseline IFN. Peg-IFN was slightly better than that of normal IFN. The recommended course of treatment was 48 weeks. After 12 weeks of treatment, Follow-up evaluation of HBsAg decline.