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目的比较聚乙二醇干扰素α-2a与替比夫定(LDT)治疗HBeAg阳性慢性乙型肝炎(CHB)的疗效。方法选取HBeAg阳性慢性乙型肝炎患者71例,分为聚乙二醇干扰素α-2a组33例和LDT组38例。比较2组治疗48周的疗效,并分析HBeAg血清学转换的相关因素。结果治疗48周时,聚乙二醇干扰素α-2a组和LDT组血清HBV DNA转阴率分别为54.5%和78.9%(P<0.05),ALT复常率分别为60.6%和81.5%(P<0.05),HBeAg血清转换率分别为36.4%和28.9%(P>0.05)。2组患者在治疗48周时HBeAg血清转换与基线ALT、HBV DNA水平、HBeAg水平无显著相关性(P>0.05)。多因素Logistic回归分析显示,聚乙二醇干扰素α-2a组治疗48周时HBeAg血清转换率与12、36、24周时HBeAg下降大于2log相关;TLD组治疗48周时HBeAg血清转换率与36、24、12周时HBeAg下降大于2log相关。结论 TLD组较聚乙二醇干扰素α-2a组有更高的HBV DNA转阴率及ALT复常率。36周HBeAg较基线下降大于2log可作为2组患者治疗48周时HBeAg血清转换的最佳预测因素。12周时HBeAg较基线下降大于2log作为聚乙二醇干扰素α-2a组治疗48周时HBeAg血清转换最佳预测因素,36周HBeAg较基线下降大于2log作为TLD组治疗48周时HBeAg血清转换最佳预测因素。
Objective To compare the efficacy of peginterferon alfa-2a and telbivudine (LDT) in the treatment of HBeAg-positive chronic hepatitis B (CHB). Methods Seventy one patients with HBeAg-positive chronic hepatitis B were divided into pegylated interferon α-2a group (n = 33) and LDT group (n = 38). The curative effect of two groups were compared 48 weeks, and the related factors of HBeAg seroconversion were analyzed. Results After 48 weeks of treatment, the serum HBV DNA negative rates in peginterferon alfa-2a group and LDT group were 54.5% and 78.9%, respectively (P <0.05). The rates of abnormality of ALT were 60.6% and 81.5% P <0.05), HBeAg seroconversion rates were 36.4% and 28.9% (P> 0.05). There was no significant correlation between HBeAg seroconversion and baseline ALT, HBV DNA level and HBeAg level in the two groups at 48 weeks (P> 0.05). Multivariate Logistic regression analysis showed that the HBeAg seroconversion rate at 48 weeks of treatment with peginterferon alfa-2a group was associated with a greater than 2 log decrease in HBeAg at 12, 36, and 24 weeks. The HBeAg seroconversion rate at 48 weeks in the TLD group was significantly correlated with 36, 24, 12 week HBeAg decline greater than 2log related. Conclusions TLD group has higher HBV DNA negative rate and ALT normalization rate than peginterferon alfa-2a group. A 36-week decrease in HBeAg by more than 2 log from baseline was the best predictor of HBeAg seroconversion at 48 weeks in both groups. HBeAg was reduced by more than 2 log from baseline at 12 weeks as the best predictor of HBeAg seroconversion at 48 weeks in peginterferon alfa-2a group, with HBeAg more than 2 log decrease over baseline at 36 weeks as HBeAg seroconversion at 48 weeks in TLD group The best predictor.