摘要
目的分析HBeAg/HBeAb双阳性慢乙肝患者的临床特征,并探讨其抗病毒疗效及临床转归。方法选取2014-2018年重庆三峡中心医院就诊的HBeAg及HBeAb双阳性慢性乙肝且符合抗病毒治疗标准的患者158例,按实际接收的治疗方案分为恩替卡韦抗病毒组(52例)、干扰素治疗组(49例)、未抗病毒治疗的对照组(57例),随访48周。观察不同处理组治疗前后疗效及患者的转归情况。结果基线HBeAg、HBeAb分布情况:158例HBeAg/HBeAb双阳性慢乙肝患者中,HBeAg≥10患者79例,HBeAb<10的患者79例,各占50%;HBV DNA水平为(4.77±1.23)Lg;抗病毒疗效:恩替卡韦组HBV DNA下降幅度及HBV DNA转阴率、ALT复常率方面均优于干扰素组(P<0.05);而干扰素治疗组则在HBeAg下降幅度、HBeAb下降幅度以及HBeAg转阴率优于恩替卡韦组(P<0.05);转归:与未抗病毒治疗组相比,抗病毒治疗后转为HBeAg阴性的患者比例及转为“仅HBsAg及HBcAb阳性的慢乙肝”患者比例明显增高(P<0.05);而未抗病毒治疗组持续“双阳性”的比例明显高于抗病毒治疗组(P<0.05);治疗前后HBeAg-Lg/HBeAb下降幅度预测HBeAg转阴的价值最大。HBeAg/HBeAb双阳性慢乙肝患者HBeAg及HBeAb滴度处于偏低水平,HBV DNA处于相对较低水平;监测HBeAg-Lg/HBeAb下降幅度有助于判断阳性HBeAg转阴率。结论对于HBeAg/HBeAb双阳性慢性乙肝患者,应用干扰素在HBeAg转阴上具有较大优势;HBeAg-Lg/HBeAb下降幅度在临床转归方面具有良好的预测效能。
Objective To analyze the clinical features of HBeAg and HBeAb double-positive patients with chronic hepatitis B,and explore the efficacy and outcomes of different antiviral regimens.Methods A total of 158 HBeAg and HBeAb double-positive patients with chronic hepatitis B who met the antiviral treatment criteria were selected from Chongqing Three Gorges Hospital from 2014 to 2018.They were divided into entecavir treatment group(n=52),interferon treatment group(n=49),and control group(without antiviral treatment,n=57)according to the actual treatment regimen,and were followed up for 48 weeks.The efficacy and outcomes of patients were observed and compared among different groups.Results Baseline distribution of HBeAg and HBeAb:among 158 HBeAg/HBeAb double positive chronic hepatitrs B patients,79 patients had HBeAg≥10,and 79 patieats had HBeAg<10,each accounting for 50%;HBV DNA level was 4.77±1.23 Lg.Antiviral efficacy:the decrease of HBV DNA level,the HBV DNA negative conversion rate,and the normalization rate of ALT were all better in the entecavir group than the interferon group(P<0.05),while the decline of HBeAg and HBeAb levels,as well as the HBeAg negative conversion rate were greater in the interferon group(P<0.05).Clinical outcomes:the proportion of patients who became HBeAg negative or only presented HBsAg and HBcAb positive was significantly larger in the antiviral groups as compared with the control group(P<0.05),while the control group showed higher proportion of continuous"double-positive"(P<0.05).In addition,the decrease range of HBeAg-Lg/HBeAb ratio before and after treatment had the greatest value in predicting HBeAg negative conversion.Conclusion For HBeAg and HBeAb double-positive patients with chronic hepatitis B,interferon treatment shows greater advantage in HBeAg negative conversion.Monitoring the decline of HBeAg-Lg/HBeAb is helpful to predict clinical outcome in the double-positive patients.
作者
安选
刘书宏
夏莉娜
巫贵成
向毅
胡鹏
罗欢
AN Xuan;LIU Shuhong;XIA Lina;WU Guicheng;XIANG Yi;HU Peng;LUO Huan(Department of Hepatology,Affiliated Three Gorges Hospital of Chongqing University,Chongqing,404000;Department of Hepatobiliary Surgery,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2022年第2期162-167,共6页
Journal of Army Medical University
基金
重庆市卫计委医学科研项目(20142136)。
