摘要
目的探讨慢性乙型肝炎患者接受聚乙二醇干扰素-2a（派罗欣）±核苷（酸）类似物（NUC）治疗前和治疗早期转氨酶明显升高者，联合双环醇（百赛诺）治疗的疗效。方法收集HBeAg阳性／阴性慢性乙型肝炎患者，给予派罗欣180μg，每周一次，皮下注射，疗程48周以上，治疗结束后随访26周。HBVDNA≥1×108拷贝／ml者联合NUC（阿德福韦或恩替卡韦）。治疗前ALT〉500U／L或派罗欣治疗第一针后ALT〉300U／L者联用双环醇25rng，每日3次，治疗1—2个月。治疗前2×ULN〈ALT〈300U／L或治疗后ALT〈300U／L者单用抗病毒治疗。比较两组患者的治疗应答和不良反应状况。结果总计54例患者（HBeAg阳性44例，HBeAg阴性10例）完成治疗及随访，其中20例联用双环醇（联合治疗组），34例未联用双环醇（对照组）。结果显示双环醇联合治疗组于治疗后ALT水平逐周下降，4周后有90％（18／20）患者ALT〈200U／L，对照组为85．3％（29／34例）。随访26周时两组ALT复常率分别为80％（16／20）和85．3％（29／34）；病毒学应答率相仿，联合治疗组较对照组HBsAg血清学转换率有明显增高（P=0．044），分别为30％（6／20）和11．8％（4／34）。结论双环醇可明显缓解干扰素治疗诱导的转氨酶升高反应，确保干扰素治疗顺利进行，且不影响其抗病毒疗效。
Objective To evaluate the effect of combination therapy with peginterferon alfa-2a （Pegasys） ＋ nucleos（t）ide analogues （NUC） and bicyclol in chronic hepatitis B with high ALT levels at baseline and during early treatment. Methods CHB patients were treated with PEG-IFNα-2a for a minimum of 48 weeks. All patients were followed up for 26 weeks post-treatment. Patients with HBV DNA/〉 1 × 108 copies/ml were combined with NUC （adefovir or entecavir） treatment. Patients with ALT 〉 500 U/L at baseline or ALT 〉 300 U/L after first injection of PEG-IFNct-2a received bicyclol treatment for 1-2 months （treatment group）. Patients with 2 x ULN 〈 ALT 〈 300 U/L and ALT 〈 300 U/L during treatment were enrolled into PEG-IFNα-2a ＋ NUC antiviral monotherapy （control group）. Responses defined as HBV DNA 〈 1 × 103 copies/ml, normal serum ALT, and HBeAg/HBsAg loss and seroconversion were analyzed at 26 weeks post-treatment. Results A total of 54 patients （44 HBeAg positive, 10 HBeAg negative）were divided into two groups according to combination of bicyclol ： treatment group （ n = 20） -those who received combinition therapy with PEG-IFNα-2a ＋ NUC and bicyclol, and control group （ n = 34）-those who were treated with PEG-IFNα-2a ＋ NUC antiviral monotherapy. During the first month of treatment, ALT levels declined gradually in treatment group. At 26 weeks post-treatment, the rates of ALT normalization and HBV DNA below the limit of 1 × 103 copies/ml were similar in both groups. Six patients in treatment group achieved HBsAg seroconversion at 26 weeks post-treatment, whereas so did 4 patients of control group（30% vs. 11.8% , P =0. 044）. Conclusion Bicyclol could significantly relief elevation of ALT induced by the IFN treatment.
出处
《中华实验和临床病毒学杂志》
CAS
CSCD
2012年第2期114-116,共3页
Chinese Journal of Experimental and Clinical Virology
