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目的:探讨恩替卡韦联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎的临床疗效以及对患者外周血Th1及Th2细胞比值的影响。方法:选择2012年1月至2015年10月在我院进行治疗的慢性乙型肝炎患者80例,将其随机分为两组,每组40例。对照组患者接受聚乙二醇干扰素α-2a治疗,联合组在对照组基础上服用恩替卡韦,比较两组患者治疗12个月后的临床疗效、治疗期间临床相关指标的变化以及治疗前后机体Th细胞免疫应答的变化情况。结果:联合组患者治疗12个月的临床疗效总有效率(95.0%)显著高于对照组(70.0%)(P<0.05),治疗1个月后ALT复常率(22.5%,50.0%,67.5%,87.5%)显著高于对照组(5.0%,20.0%,42.5%,62.5%)(P<0.05),治疗3个月后血清HBV DNA转阴率(45.0%,80.0%,90.0%)显著高于对照组(17.5%,45.0%,55.0%)(P<0.05),治疗6个月后HBe Ag转阴率(52.5%,72.5%)显著高于对照组(30.0%,50.0%)(P<0.05)。治疗期间,两组患者的Hbe Ag血清转换率比较差异无统计学意义(P>0.05)。两组患者治疗1个月后外周血CD3~+CD4~+IFN-γ~+较治疗前均显著降低(P<0.05),对照组CD3~+CD4~+IL-4~+在治疗3个月后显著上升(P<0.05),联合组则在治疗6个月后显著上升(P<0.05);而联合组患者在治疗1个月后CD3~+CD4~+IFN-γ~+(36.7±8.2,34.8±7.9,32.1±7.5,23.7±7.3)显著高于对照组(34.2±7.6,31.4±8.2,29.3±8.1,19.8±7.7)(P<0.05),联合组治疗后6个月CD3~+CD4~+IL-4~+(0.7±0.4,1.1±0.2)则显著低于对照组(0.9±0.3,1.3±0.6)(P<0.05)。结论:恩替卡韦联合聚乙二醇干扰素α-2a治疗慢性乙型肝炎的临床疗效显著,可有效抑制HBV复制,可能通过调控Th细胞免疫应答,协同抗病毒效应,从而清除HBV。
Objective: To investigate the clinical efficacy of entecavir combined with pegylated interferon α-2a in the treatment of chronic hepatitis B and its effect on the ratio of Th1 and Th2 cells in peripheral blood of patients. Methods: Eighty patients with chronic hepatitis B who were treated in our hospital from January 2012 to October 2015 were randomly divided into two groups (n = 40 in each group). Patients in the control group were treated with peginterferon alfa-2a. The combination group was given entecavir on the basis of the control group. The clinical efficacy of the two groups after 12 months of treatment was compared. The changes of the clinically relevant indexes during the treatment and the changes of the Th Changes in cellular immune response. Results: The total effective rate (95.0%) in the combined group was significantly higher than that in the control group (70.0%) at 12 months (P <0.05). After 1 month of treatment, the ALT normalization rate (22.5%, 50.0% 67.5%, 87.5%) were significantly higher than those in the control group (5.0%, 20.0%, 42.5%, 62.5%, P <0.05) ) Was significantly higher than that of the control group (17.5%, 45.0%, 55.0%, P <0.05). After 6 months of treatment, the HBeAg negative rates (52.5%, 72.5% ) (P <0.05). There was no significant difference in Hbe Ag seroconversion rate between the two groups during treatment (P> 0.05). The levels of CD3 ~ + CD4 ~ + IFN-γ ~ + in peripheral blood of two groups were significantly decreased (P <0.05) one month after treatment, while the levels of CD3 ~ + CD4 ~ + IL- (P <0.05), and the combined group increased significantly after 6 months of treatment (P <0.05). In the combined group, CD3 ~ + CD4 ~ + IFN-γ ~ + ± 8.2,34.8 ± 7.9,32.1 ± 7.5,23.7 ± 7.3) were significantly higher than those in the control group (34.2 ± 7.6,31.4 ± 8.2,29.3 ± 8.1,19.8 ± 7.7) (P <0.05) CD3 ~ + CD4 ~ + IL-4 ~ + (0.7 ± 0.4,1.1 ± 0.2) was significantly lower than the control group (0.9 ± 0.3,1.3 ± 0.6) (P <0.05). Conclusion: The clinical efficacy of entecavir combined with pegylated interferon α-2a in the treatment of chronic hepatitis B is significant, which can effectively inhibit HBV replication. It may clear out HBV by regulating Th cell immune response and synergizing antiviral effect.